The Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services (HHS) released the 2023 Notice of Benefits and Payment Parameters Final Rule, finalizing many of the proposed changes. Overall, the final rule seeks to strengthen the coverage offered by qualified health plans (QHPs) on the federal Marketplace. These policies will also ensure consumers can more easily find the right form of quality, affordable coverage for their circumstances.
The final rule includes:
- A requirement that issuers in the Federally-facilitated Marketplace (FFMs) and State-based Marketplaces on the Federal Platform (SBM-FPs) offer standardized plan options at every product network type, at every metal level, and throughout every service area that they offer non-standardized options in plan year (PY) 2023 and beyond.
- Changes to the federal network adequacy reviews, which will focus on time and distance that are necessary to meet the unique health care needs of QHPs enrollees, appointment wait time standards beginning PY 2024 and whether providers offer telehealth options.
- Advancing health equity through various policies such as refining Essential Health Benefits (EHB) nondiscrimination policy for health plan designs and raising the Essential Community Provider (ECP) threshold from 20% to 35%.
- Finalizing an FFM user fee rate of 2.75% of premium and an SBM-FP user fee rate of 2.25% of premium.
- Finalizing two of the three proposed model specification changes to the risk adjustment models, improving risk prediction for the lowest and highest risk enrollees.
- A finalized risk adjustment user fee of $0.22 per member per month.
- Policies to enhance the consumer experience
Source: U.S. Centers for Medicare & Medicaid Services (CMS)
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