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CMS Proposes 2020 ACA Marketplace Payment Notice, Drafts Letter to Issuers

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

The proposed changes aim to further the Trump administration’s goals to lower premiums, increase market stability, reduce regulatory burden, and protect taxpayers.

Provisions in the proposed payment notice apply to:

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

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

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

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

Notably, neither the payment notice nor the draft letter to issuers propose changes to standards for network adequacy and inclusion of essential community providers in QHP networks. Standards remain unchanged from the 2019 health insurance market regulations, issued in April 2018.

Comments on the payment notice and the draft letter to issuers are due Feb. 19.

CMS also issued the:

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

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

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