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CMS Finalizes ACA Marketplace Benefit, Payment Notice

The Centers for Medicare & Medicaid Services (CMS) finalized the Notice of Benefit and Payment Parameters for the Affordable Care Act’s health insurance marketplace and the annual letter to issuers offering plans on the federally facilitated marketplaces for plan years beginning on or after Jan. 1, 2020.

Provisions in the payment notice apply to:

  • qualified health plans offered on the marketplaces;
  • plans in the individual, small-group, and large-group markets; and
  • self-funded group health plans.

The proposed rule also includes provisions related to risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and policies related to navigators, eligibility, and enrollment.

For 2020, CMS reduced the user fees charged to issuers offering plans on the federally facilitated marketplace and state-based marketplaces on the federal platform. CMS also finalized proposals allowing issuers to adopt midyear formulary changes to encourage enrollees to use lower-cost generic drugs.

The draft letter to issuers focuses on the changes in the finalized payment notice and refers issuers to the final 2018 and 2019 payment notices for information on provisions the agency did not change.

CMS also released the key dates charts for the 2019 calendar year.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.

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