An Update on the Benefit and Payment Parameters Final Rule

Once again there are changes on the horizons for health plans and State-Based Marketplaces (SBMs). The Centers for Medicare & Medicaid Services (CMS) finalized its Updating Benefit and Payment Parameters final rule in efforts to further extended and promote health coverage. This rule expands on similar efforts made in Parts 1 and 2 of the Notice of Benefit and Payment Parameters for 2022.

Expansion of Open Enrollment 2022

Perhaps the biggest news set to impact everyone looking for health insurance is the expansions of Open Enrollment (OE) 2022 for the Federally-Facilitated Marketplace (FFM). Members will be able to enroll for an additional 30 days with OE ending on January 15th instead of December 15th.

SBMs have the option to expand their OE Period as well. They do not have to extend the timeframe for the entire 30 days, but instead can set their own end date as long as it is no sooner than December 15th.

New Special Enrollment Periods (SEPs)

Marketplaces have the option to provide a monthly SEP for APTC-eligible members that have an annual household income at or below 150% of the Federal Poverty Line (ARP). This expansion in SEP aims to encourage low-income members to capitalize on lower and free premiums that resulted from the American Rescue Plan (ARP). These SEPs will vary by SBM.

Additional Support Post-Enrollment

Part 3 of the Notice of Benefit and Payment Parameters reinstates requirements for post-enrollment member services for Navigators. In efforts to improve member knowledge and health insurance literacy, Navigators helps members, and this assistance further expands to post-enrollment services. Members will now have an avenue to learn about processes such as marketplace appeals and premium tax credit reconciliation.

User Fees On the Rise

FFM user fees for the 2022 benefit year are set to raise from the rates first stated in part 1 of the 2022 Payment Notice. FFM user fees raised to 2.75% from 2.25%. The SBM-FP user fee rate also increased, going from 1.75% to 2.25%. It is of note that these new rates are still lower than those of the current 2021 benefit year user rates.

This increase in projected fees over a short period of time are said to help fund increased consumer communication and the expansion of Navigator activities.

Stricter Regulations for States

The rule repeals the Exchange Direct Enrollment option that no state has yet acted on. The Exchange Direct Enrollment gave states the option to facilitate the enrollment of members on third party vendor sites. These partnered vendors would function as private brokers so states would not have to utilize the FFM or create their own SBM. There was fear that this program would cause unnecessary confusion for members and lead to overall lower enrollment rates.

This new rule replaces the language previously stated on the October 2018 “State Relief and Empowerment Waivers” guidance in Part 1 of the 2022 final rule. The rule aims to rescind the 2018 guidance and replace them with stricter Obama-era standards.

The Departments also added flexibility to public notice requirements and Section 1332 waivers, if certain criteria is met. Processes and procedures for amendments and extensions of Section 1332 waivers were also clarified and elaborated on.

These adjustments are all in the goal of strengthening the ACA and increasing health insurance literacy. More policies to this effect are expected from the Biden-Harris Administration.

The ACA Marketplace continues to see growth and participation. Its reinforced structure, the surge in funding, additional support, and the overwhelming need for its benefits will ensure it continues to thrive in the years to come. For the technology needed to capitalize on the expanding ACA Marketplace through tools such as Enhanced Direct Enrollment, look to W3LL! Let us help you leverage the latest advantages of the bigger and better platform that is the ACA Marketplace today. Find out how the latest in the Benefit and Payment Parameters Final Rule will effect SBMs and health plans.