CMS Issues Final Rule on HHS Notice of Benefit and Payment Parameters for 2024
Published April 18, 2023
The Department of Health and Human Services (HHS) though the Centers for Medicare & Medicaid Services (CMS) released a final rule addressing payment parameters and provisions for 2024 related to the risk adjustment and risk adjustment data validation programs, as well as 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs).
The final rule finalizes changes to:
- Standards for issuers and Marketplaces, as well as requirements for agents, brokers, web-brokers, and assisters that help consumers with enrollment through Marketplaces that use the federal platform.
- Increase access to health care services by revising the network adequacy and essential community provider (ECP) regulations to provide that all individual market qualified health plans (QHPs), including stand-alone dental plans (SADPs), and all Small Business Health Option Program (SHOP) plans, including SHOP SADPs, across all Marketplace-types must use a network of providers that comply with the network adequacy and ECP standards in those sections, and to remove the exception that these sections do not apply to plans that do not use a provider network.
- Standardize plan options to simplify choice and improve plan selections. These provisions attempt to make it easier for consumers to select a health plan that best fits their individual needs and budget by refining designs for standardized plan options.
- For the federal platform, QHP issuers will now be limited to four non-standardized plans offerings per metal level, network type, and dental and/or vision coverage inclusion. There will be some exceptions for plans with extra dental and/or vision coverage. State-based marketplace offerings, stand-alone dental plans (SADPs), and all Small Business Health Option Program (SHOP) plans will not have to comply.
- Beginning January 1, 2024, Marketplaces have the option to implement a new special rule for consumers losing Medicaid or Children’s Health Insurance Program (CHIP) coverage that is also considered minimum essential coverage (MEC), under which consumers will have up to 90 days after their loss of Medicaid or CHIP coverage to select a plan for Marketplace coverage via a Special Enrollment Period (SEP).
The final regulations are effective June 18, 2023.
Additional Information
CMS Fact Sheet