CHA News

CMS Releases Proposed Notice of Benefit and Payment Parameters Rule for 2021

For CEOs, CFOs, government relations executives

This post has been archived and contains information that may be out of date.

Last week, the Centers for Medicare & Medicaid Services (CMS) issued its proposed annual Notice of Benefit and Payment Parameters Rule for 2021, also known as the Proposed 2021 Payment Notice. This proposed rule would update regulatory and financial standards applied to issuers and exchanges, as well as set parameters for the risk-adjustment program.

Under the proposed rule:

  • Periodic data-matching standards would be amended to help ensure premium subsidies are not inappropriately paid to enrollees determined to be deceased or dually eligible for Medicare. 
  • States would be required to annually notify CMS of any state-required benefit mandates for which the Affordable Care Act (ACA) requires states to pay certain costs. CMS indicates limited information has been collected on such mandates, creating a potential risk of taxpayers and consumers inappropriately footing the bill.

Furthermore, CMS solicits public comment on new automatic re-enrollment processes for enrollees whose share of their premium after applying premium subsidies is $0. This process is intended to reduce the risk of incorrect expenditures on subsidies that cannot be recovered through reconciliation. More information about the proposed rule is available in a CMS fact sheet.

In conjunction with the release of the Proposed 2021 Payment Notice, CMS published a bulletin to extend, for one additional year, the non-enforcement policy that gives states the flexibility to allow issuers to continue offering plans that do not meet all mandates and restrictions in the ACA. Comments are due March 2.

Covered California has issued the attached press release in response to the proposed rule, noting concern that some of the proposals reinforce actions taken by the administration that threaten the stability of the individual market and diminish consumers’ ability to choose the right plan for themselves and their family. Covered California will provide full written comments on the notice prior to the March deadline.