On April 30, 2021, the Biden administration released the final rule HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards. This is the second final rule released that includes policies for the health insurance exchanges in 2022. The first rule was released in the final days of the Trump administration [...] Read More
The Department of Health and Human Services (HHS), in conjunction with the Departments of Labor and the Treasury, released a proposed rule for grandfathered group health plans and grandfathered group health insurance coverage. The agencies believe that the proposals in this rule would provide greater flexibility for these plans to make changes to some cost-sharing [...] Read More
On the evening of May 7, 2020, the Department of Health and Human Services (HHS) released the final rule for qualified health plans (QHPs) that operate on the health insurance Exchanges established by the Affordable Care Act (ACA), as well as several other types of plans operating off-exchange. Policies finalized in this rule address the [...] Read More
On April 18, 2019, the Department of Health and Human Services (HHS) released the final 2020 notice of benefit and payment parameters. This final rule outlines policies for qualified health plans (QHPs), the exchanges, and navigators. These policies will be effective for the 2020 plan year. HHS Will Allow Plans to Exclude Value of Copay [...] Read More
On January 17, 2019, the Department of Health and Human Services (HHS) released the proposed benefit and payment parameters for qualified health plans (QHPs) for 2020. The rule includes proposed changes to requirements for QHPs, Exchanges, Navigators, and web brokers that offer enrollment in QHPs outside of HealthCare.gov. Highlights of the rule include: Proposals that [...] Read More
Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule and 2019 […]
Read MoreThe Department of Health and Human Services (HHS) has released a proposed rule that, if finalized, will require federal and state-based Exchanges to conduct more frequent checks to verify enrollee eligibility for premium tax credits, cost-sharing assistance, and Medicaid. Individuals would also be able to authorize Exchanges to automatically terminate coverage once the individual becomes [...] Read More
CMS has released the risk adjustment summary report for the 2017 benefit year for the individual and small-group markets. The program, included as a permanent fixture of the Affordable Care Act (ACA), is designed to discourage adverse selection by health plans by providing transfer payments to plans with higher-than-expected health care costs. On a summer […]
Read MoreCMS has announced that the agency will halt payments to health plans under the Affordable Care Act’s risk adjustment program, pending a current court case in New Mexico District Court. The agency was scheduled to disburse $10.4 billion in payments to plans for the 2017 benefit year in the fall. The Saturday afternoon announcement drew […]
Read MoreThis afternoon, the Department of Health and Human Services released the requirements for qualified health plans (QHPs) offered through the Affordable Care Act’s (ACA’s) Exchanges. Generally, the requirements will apply to plan year 2019; exceptions are noted below. The rule includes many proposals aimed to reduce burdens on states and grant health plan issuers more […]
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