CMS Releases 2017 Benefit and Payment Parameters Rule

CMS Releases 2017 Benefit and Payment Parameters

On February 29, the Department of Health and Human Services (HHS) released the Notice of Benefit and Payment Parameters rule for 2017. The rule, released annually, sets forth payment parameters for the upcoming year and notifies issuers of any new changes and standards. This year’s rule, running 538 pages, covers not only payment parameters but also provides updates to market rules and eligibility, enrollment and benefits requirements. Let’s take a look at some of the items included in the final rule.


Standardized Options

Insurers will now be able to offer plans with certain standardized cost-sharing structures as “standardized options.” Included in the rule are six designs for these plans including one at the gold level, one bronze, and one silver with three silver cost-sharing reduction variations at 73 percent, 87 percent and 94 percent actuarial-value levels. The deductible, copayment or coinsurance, and annual limitation on cost sharing are fixed in each standardized plan option. Insurers are not required to offer the standardized plans; however, if they do choose to offer these standardized options, insurers will still be able to offer non-standardized plans as well.


Network Adequacy

In the final rule, states are tasked with selecting minimum network adequacy standards. In adopting these standards, HHS clarifies that the National Association of Insurance Commissioners (NAIC) has released a Network Adequacy Model Act that states can adopt in whole or in part. Additionally, two provisions are included dealing with continuity of care applicable to qualified health plans on federally-facilitated marketplaces. First, issuers are required to provide written notice to enrollees if there is a network change or their provider is discontinued from the network. This notice must be given as soon as practical or within 30 days. Secondly, where a provider is terminated without cause and an enrollee is in active treatment, the issuer will be required to allow an enrollee to continue treatment until it is complete or for 90 days, whichever timeframe is shorter. Finally, cost sharing for certain out-of-network services provided at in-network facilities must now be counted towards the enrollee’s annual cost-sharing limits.


Updates for Navigators

The duties of Navigators are expanded under the new rule, to include post-enrollment assistance such as helping consumers file eligibility appeals and apply for exemptions. Navigators must also provide targeted assistance to various underserved and vulnerable populations, including harder-to-reach populations and the remaining uninsured.


Updates for Brokers

Moving forward, HHS is seeking to streamline the enrollment process by allowing both health insurance carriers and web-brokers to offer web-based services that will allow individuals to complete the enrollment process on a single website. For example, an individual can complete the entire application, including subsidy determinations, on a single site as opposed to traveling back and forth between and other websites. While HHS sees the value in this process, they do not plan to implement the requirement until 2018.


Changes to Open Enrollment

Open enrollment in 2017 and 2018 will be from November 1 to January 31, the same dates as the 2016 open enrollment cycle. However, in 2019, open enrollment will run from November 1 to December 15. Changes to the special enrollment periods are also addressed in the final rule.


Stay Tuned

These changes represent just a small fraction of the final rule. Stay tuned as we continue to track and report on updates to enrollment procedures, new plan options, and important updates for brokers.

The views expressed in this post do not necessarily reflect the official policy, position, or opinions of BenefitMall. This update is provided for informational purposes. Please consult with a licensed accountant or attorney regarding any legal and tax matters discussed herein.

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