CMS Finalizes New Marketplace Payment Rule, Effective January 17, 2017

Late in the day on December 16, 2016, the Centers for Medicare and Medicaid Services (CMS) finalized the Benefit and Payment Parameters rule for 2018. (fact sheet). It also released the final 2018 Letter to Issuers in the Federally Facilitated Marketplaces. Accompanying the rule and letter, CMS also released a number of additional documents, including guidance on the uniform rate review timeline, a list of key dates for 2017, the final actuarial value (AV) calculator for 2018 and AV calculator methodology, a guidance regarding age curves and state reporting, a frequently asked question (FAQ) on second-lowest cost silver plans, an agent and broker compensation and discriminatory marketing FAQ, and the final list of essential community providers for 2018. Finally, at its REGTAP.info website, CMS released updates on batch auto-enrollments; guidances on transfers of accumulated cost-sharing in cost-sharing reduction plans; and guidances on final adjustments to the cost sharing reduction portion of advance payments for the 2016 benefit year. In sum, the Obama administration seems to have in one massive dump completed its regulatory agenda for implementing the health insurance title of the ACA. Overview The rule finalizes a proposed rule issued in August and November’s draft issuer letter. The final rule also finalizes an interim final rule on special enrollment periods and consumer oriented and operated plans (CO-OPs) released in May. The “payment notice,” as the rule is c...
Source: Health Affairs Blog - Category: Health Management Authors: Tags: Following the ACA Insurance and Coverage Payment Policy benefit and payment parameters Congressional Review Act federally facilitated marketplaces letter to issuers Source Type: blogs