CMS finalized its annual Notice of Benefit and Payment Parameters.
Here are eight provisions:
1. CMS recalibrated the risk adjustment formula for the quality health plan payment parameters using recent data. The new formula includes separate growth rates for traditional drugs, specialty drugs and medical/surgical expenditures.
2. The law establishes a lower default risk adjustment charge for small insurers, raises the fault risk adjustment charge and updates the premium adjustment percentage.
3. CMS' provisions set the 2017 maximum annual limitation on cost sharing at $7,150 for individual coverage and $14,300 for family coverage.
4. The rules mandate QHP issuers to provide enrollees written notice if they decide to discontinue a provider. If an issuer terminates a provider without cause, the issuer must count such out-of-pocket expenses toward an enrollee's out-of-pocket maximum unless notification requirements are met.
5. CMS must include ratings on HealthCare.gov on each QHP's relative network plan starting in 2017.
6. The rules enable QHP issuers to offer plans with standardized cost-sharing options to allow consumers to compare plans.
7. QHP issuers must verify contracted hospitals with more than 50 beds either work with a Patient Safety Organization or implement an evidence-based initiative to enhance healthcare quality through data collection and patient safety events' analysis.
8. For coverage in 2017 and 2018, open enrollment commences in November of the previous year through January 31 of the coverage year. For 2019 coverage, open enrollment will run from November 1 through December 15 of the year preceding coverage.
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