CMS issues final rule on notice of benefit and payment parameters for 2018

The Centers for Medicare & Medicaid Services late this afternoon issued a final rule on the notice of benefit and payment parameters standards for health insurance issuers and the Health Insurance Marketplaces in 2018. The rule sets forth the payment parameters and provisions related to the risk-adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for federally-facilitated exchanges and state-based exchanges on the federal platform. CMS finalized several changes with respect to the risk-adjustment program, including better accounting for partial-year enrollments and using prescription drug data as one source of information on diagnoses. CMS also finalized policies with respect to expanding the number of standardized plan options available; applying cost sharing resulting from bills from out-of-network providers at in-network facilities toward the cost sharing limits in off-exchange products; and incorporating an “integrated delivery system” identifier into plan listings to help consumers identify plans, among other related topics. The provisions in the rule will be effective 30 days after publication in the Federal Register. For more information, see the CMS factsheet. AHA members will receive a Special Bulletin with further details next week.