HHS Finalizes Various Benefit and Payment Parameters and Provisions for 2022 and Beyond
HHS has finalized regulations that amend various benefit and payment parameters and other ACA insurance market and Exchange-related rules.
Published: 09.23.2021
The United States Department of Health and Human Services (HHS) has finalized regulations that amend various benefit and payment parameters and other Affordable Care Act (ACA) insurance market and Exchange-related rules. The final regulations adopt the rules proposed in July without significant changes.In the Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond final rule, the Centers for Medicare & Medicaid Services (CMS) finalizes standards for issuers, Marketplaces, and Navigators. This rule is a continuation of the recent rulemaking process, as seen in parts 1 and 2 of the Notice of Benefit and Payment Parameters for 2022 final rule, published on January 19 and May 5, 2021, respectively.
Overall, the rule expands access to health insurance coverage through the Marketplaces by lengthening the annual Open Enrollment Period, restoring and expanding Navigator duties, and minimizing burden and confusion for consumers.
Here are some highlights:
Improving Access to Coverage
- Navigator Duties
- FFM and State-based Marketplace on the Federal Platform (SBM-FP) User Fees
- 2022 Open Enrollment Extended and beyond
- Monthly Special Enrollment Period (SEP) for Advance Payments of Premium Tax Credits (APTC)Eligible Consumers with Household
- Income up to 150% of the Federal Poverty Level (FPL) whose Applicable Taxpayer has an Applicable Percentage of Zero
- SEP Clarification
- Separate Billing
- Exchange Direct Enrollment Option Repeal
- Section 1332 Waiver Policies
CMS Fact Sheet: https://www.cms.gov/newsroom/fact-sheets/patient-protection-and-affordable-care-act-updating-payment-parameters-section-1332-waiver
Federal Register: https://public-inspection.federalregister.gov/2021-20509.pdf
