Wednesday, March 2, 2016

CMS Finalizes ACA Marketplace 2017 Rule

Dianne De La Mare

The Centers for Medicare & Medicaid Services (CMS) has released a Factsheet  and Final Rule, Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017, a “sweeping rule,” to ensure that the Affordable Care Act (ACA) Marketplace continues to work smoothly.

The final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance and risk corridors programs; cost-sharing parameters and reductions; and user fees for Federally-facilitated Exchanges. It also provides additional changes regarding the open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program; stand-alone dental plans; third-party payments to qualified health plans; definitions of large and small employers; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.

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