CMS Issues Proposed Payment Notice for 2020 Coverage Year

January 2019 ~

CMS has issued the proposed annual Notice of Benefit and Payment Parameters for the 2020 benefit year (proposed 2020 Payment Notice).

The 2020 rule proposes regulatory and financial parameters applicable to qualified health plans (QHPs) on the Exchanges, plans in the individual, small group, and large group markets, and self-funded group health plans. According to the announcement, these changes proposed in the rule would “further the agency’s goals of lowering premiums, enhancing the consumer experience, increasing market stability, reducing regulatory burdens, and protecting taxpayers”.

For the exchange and QHP provisions, the proposal would loosen requirements for navigators, who help consumers navigate the individual exchanges; streamline direct enrollment for QHP issuers and applicants; segregate funds for abortion services; make changes to prescription drug benefits; and voice support for a legislative solution that would end silver loading, or the rising prices of silver-tiered health plans.

The proposed rule also seeks to recalibrate risk adjustment models using more recent 2017 and 2016 data and bolster the risk adjustment data validation audit program. For 2020, the administration also proposed lowering the user fee rate on the federally-facilitated exchange (FFE) from 3.5% to 3% of premiums for QHPs sold, and lower the state-based exchanges on the federal platform fee to 2.5% from 3% of the premium for the 2019 benefit year.

As well, the proposal also would changes to the maximum annual limitation on cost-sharing parameters and exempts individuals from the requirement to have minimum essential coverage if the amount they pay exceeds a particular percentage of household income for a year.

For additional information refer to the following resources provided by CMS: the Proposed HHS Notice of Benefit and Payment Parameters for 2019 Fact Sheet, the 2020 Letter to Issuers, the 2019 Rate Review Timeline Bulletin, the Proposed Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment, the 2020 Actuarial Value (AV) Calculator documents.

And full details on the proposed changes, view the Proposed Rule here(pdf).

Source(s): Proposed Rule; CMS Fact Sheet; 2020 Letter to Issuers; 2019 Rate Review Timeline Bulletin; Proposed Key Dates for Calendar Year 2019: QHP Certification in the FFEs; Rate Review; Risk Adjustment; 2020 Actuarial Value (AV) Calculator documents;
AdvantEdge