CMS issues proposed rule on notice of benefit and payment parameters for 2017

The Centers for Medicare & Medicaid Services late this afternoon issued a proposed rule on the notice of benefit and payment parameters standards for health insurance issuers and the Health Insurance Marketplaces. The proposed rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for federally-facilitated exchanges. It asks states to establish a provider network adequacy standard for health plans in the federal Marketplace, subject to minimum criteria that CMS will establish at a later date. CMS also seeks feedback on surprise billing situations where patients unknowingly are treated by an out-of-network physician at a facility in their network. The proposed rule also would make changes to the premium stabilization programs, including by recalibrating the risk adjustment formula using more recent data. It also would provide additional standards for the annual open enrollment period for the individual market for the 2017 benefit year; essential health benefits; qualified health plans; updated standards for Exchange consumer assistance programs; the Small Business Health Options Program; and the medical loss ratio program, among other items. The proposed rule also would expand on current regulations related to patient safety standards for hospitals. It would require QHP issuers that contract with a hospital with more than 50 beds to verify that the hospital either has an agreement with a patient safety organization and implements a mechanism for comprehensive person-centered hospital discharge, or implements other evidence-based initiatives to improve care and reduce harm such as through Hospital Engagement Networks and Quality Improvement Organizations. The rule proposes that the annual open enrollment period for 2017 begin on Nov. 1, 2016 and run through Jan. 31, 2017. See the CMS factsheet for more information. Comments are due to CMS by Dec. 21. AHA members will receive a Special Bulletin with further details next week.