2017-23599: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019

Summary

This proposed rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It proposes changes that would enhance the role of States as related to essential health benefits (EHB) and qualified health plan (QHP) certification; and would provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes proposed changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics.

The agency’s own summary, as published.

What this changes

Amends 7 parts of the Code of Federal Regulations — the standing rules this notice rewrites.

• 45 CFR 147 Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets
• 45 CFR 153 Standards Related to Reinsurance, Risk Corridors, and HHS Risk Adjustment Under the Affordable Care Act
• 45 CFR 154 Health Insurance Issuer Rate Increases: Disclosure and Review Requirements
• 45 CFR 155 Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act
• 45 CFR 156 Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
• 45 CFR 157 Employer Interactions with Exchanges and Shop Participation
• 45 CFR 158 Issuer Use of Premium Revenue: Reporting and Rebate Requirements