The 2017 Benefit and Payment Parameters Proposed Rule: Drilling Down

On November 21, 2015, the Centers for Medicare and Medicaid issued a notice of proposed rulemaking (NPRM) for the 2017 Benefit and Payment Parameters (BPP), the annual rule through which it sets out Affordable Care Act policy for the coming years. This is the second of two posts analyzing this proposed rule. The first post summarized the provisions of the rule of most interest to a broader audience. This post will drill down into the details of the rule. One note to begin: throughout, the rule uses the legally precise term “exchange” rather than the more recent term “marketplace.” This post will use the term exchange rather than marketplace throughout (and federally facilitated exchange or FFE rather than federally facilitated marketplace, or FFM), but it should be understood that both terms mean the same thing. Topics covered in this post include definitions; rating issues; guaranteed availability and renewability; student health coverage; risk adjustment; reinsurance and risk corridors; rate review; exchange establishment; essential health benefits; navigators and assisters; brokers and agents; notices to employers; financial subsidy eligibility verification; reenrollment and binder payments; open and special enrollments; eligibility appeals; individual responsibility exemptions; the SHOP exchange; selective contracting and standard plans in the FFE; FFE user fee; the drug formulary exceptions process; the premium adjustment percentage; the actuarial value calculat...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Featured Following the ACA Insurance and Coverage Source Type: blogs