HHS Proposes Standard Cost Sharing Designs & "Leasing" Fees for the Federal Marketplace

The Department of Health and Human Services (HHS), in a draft Notice of Benefit and Payment Parameters, has proposed several significant regulatory changes for 2017, including: establishing voluntary standard cost sharing designs for bronze, silver, and gold plans; creating provider network adequacy standards based on time and distance; and creating protections against excessive cost sharing for services rendered by out-of-network providers in in-network facilities. Additionally, HHS proposed a mechanism for State-based Marketplaces that use the federal technology platform—HealthCare.gov—for eligibility and enrollment functions to make 3% user fee payments. The draft notice is an annual rulemaking in which HHS sets policies for the Affordable Care Act Marketplaces and qualified health plans sold on Marketplaces, as well as other federal policies and programs that apply to health insurance coverage, such as the risk adjustment program. Comments on the draft notice are due December 21 and the final notice will likely be released in February 2016.

HHS Announces Intent to Make Full Risk Corridors Payments to Issuers

The Department of Health and Human Services (HHS) released guidance reiterating the Secretary's requirement to make full 2014 risk corridors payments to issuers, after announcing in October that it would make payments totaling 12.6% of issuers' 2014 benefit year payment requests. Consistent with previous guidance, the remaining 2014 payments will be made from 2015 collections, and, if necessary, 2016 collections. In the event HHS does not have sufficient funds to make full risk corridors payments for the 2016 program year, it will explore alternate funding sources, including working with Congress.