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CMS Issues 2021 ACA Marketplace Proposed Rule, Draft Letter to Issuers

The Centers for Medicare & Medicaid Services (CMS) on Jan. 31 released the notice of payment and benefit parameters proposed rule for the Affordable Care Act’s health insurance marketplaces and draft letter to issuers for plans offered on federally facilitated marketplaces.

Details of Proposed Rule

The proposed rule updates regulatory and financial requirements for the marketplaces and insurance issuers. CMS notes that the proposed provisions aim to lower premiums and strengthen competition and choice for consumers seeking coverage through the marketplaces.

For 2021, CMS proposes to lower the user fees — below 2020 plan year levels — charged to issuers offering plans on the federally facilitated marketplace and state-based marketplaces on the federal platform.

CMS also outlines how issuers can develop value-based insurance designs for qualified health plans (QHPs). Value-based QHPs would be a voluntary option for issuers, designed to provide consumers high-quality care at lower costs. CMS proposes updates to provisions related to risk adjustment and risk-adjustment data validation programs, which ensure plans are not avoiding high-cost patients.

The rule provides clarification on the treatment of drug manufacturer coupons, proposes several reporting requirements, and calls for active re-enrollment for consumers who have no premiums after application of tax credits.

Details of Letter

The draft letter to issuers mirrors the payment notice proposed rule. CMS directs issuers to previous marketplace rulemaking for information about provisions the agency is not proposing to change.

CMS does not propose any changes to network adequacy and essential community provider inclusion in QHP networks in the proposed rule or draft letter to issuers. The standards remain unchanged from 2018 health insurance marketplace rulemaking.

Additional Resources

CMS also released these resources:

Comments on the proposed rule are due March 2, with comments on the draft letter to issuers due Feb. 24.

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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