{"description":"Documents matching 'related defrayal state-required benefits addition'","count":43,"total_pages":3,"next_page_url":"https://www.federalregister.gov/api/v1/documents?conditions%5Bterm%5D=related+defrayal+state-required+benefits+addition&format=json&page=2","results":[{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Rule","abstract":"This final rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); requirements related to defrayal for the cost of any State-required benefits in addition to the EHB; cost- sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive plan years; QHP issuer quality improvement strategies (QISs); and revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States. This final rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-10050","html_url":"https://www.federalregister.gov/documents/2026/05/20/2026-10050/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-05-20/pdf/2026-10050.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-10050.pdf?1779135308","publication_date":"2026-05-20","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"that beginning with PY 2028, a <span class=\"match\">State-required</span> <span class=\"match\">benefit</span> will be considered “in <span class=\"match\">addition</span> to EHB” (and thus not EHB) if it is required by a State action taking place after December 31, 2011; applicable to the small group and/or individual markets; specific to required care, treatment, or services; and not required by State action for purposes of compliance with Federal requirements. Under this finalized policy, such <span class=\"match\">State-required</span> <span class=\"match\">benefits</span> will be considered in <span class=\"match\">addition</span> to EHB regardless of whether the required <span class=\"match\">benefits</span> are embedded in the State's EHB-benchmark"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2027; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed rule contains provisions to improve implementation of the Patient Protection and Affordable Care Act, including payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2027 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also includes provisions related to civil money penalties (CMPs) for noncompliant issuers and other responsible entities; standards governing agents, brokers, and web-brokers; the expansion and codification of hardship exemption eligibility; implementation of the State Exchange Improper Payment Measurement (SEIPM); provider access standards and essential community provider standards for QHP certification; QHP certification of non-network plans; a prohibition on issuers from including routine non-pediatric dental services as an Essential Health Benefit (EHB); cost-sharing flexibilities for catastrophic and individual market bronze plans; establishment of catastrophic plans with plan terms of up to 10 consecutive years; QHP issuer quality improvement strategies (QISs); revisions affecting which enrollees are included in Federal Basic Health Program (BHP) payment calculations to States; and seeks comment on potential adjustments to other Federal standards, including the Federal medical loss ratio (MLR) standard in the individual market. This proposed rule also includes amendments to implement certain provisions of the Working Families Tax Cut (WFTC) legislation.","document_number":"2026-02769","html_url":"https://www.federalregister.gov/documents/2026/02/11/2026-02769/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2027-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2026-02-11/pdf/2026-02769.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2026-02769.pdf?1770671709","publication_date":"2026-02-11","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"provide that beginning with PY 2027, a <span class=\"match\">State-required</span> <span class=\"match\">benefit</span> would be considered “in <span class=\"match\">addition</span> to EHB” (and thus not EHB) if it is: required by a State action taking place after December 31, 2011; applicable to the small group and/or individual markets; specific to required care, treatment, or services; and not required by State action for purposes of compliance with Federal requirements. Under this proposal, such <span class=\"match\">State-required</span> <span class=\"match\">benefits</span> would be considered in <span class=\"match\">addition</span> to EHB regardless of whether the required <span class=\"match\">benefits</span> are embedded in the State's EHB-benchmark"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS-RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; permissible plan-level adjustment to the index rate to account for cost-sharing reductions (CSRs); reconsideration standards for certification denials; changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a policy to publicly share aggregated, summary- level Quality Improvement Strategy (QIS) information on an annual basis; and revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2025-00640","html_url":"https://www.federalregister.gov/documents/2025/01/15/2025-00640/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2025-01-15/pdf/2025-00640.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2025-00640.pdf?1736802922","publication_date":"2025-01-15","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Office of the Secretary"}],"excerpts":"with the 2024 <span class=\"match\">benefit</span> year. In <span class=\"match\">addition</span>, we approved a 25 percent reduction to 2023 <span class=\"match\">benefit</span> year HHS risk adjustment transfers in Alabama's individual market and a 10 percent reduction to 2023 <span class=\"match\">benefit</span> year HHS risk adjustment transfers in Alabama's small group market. We also finalized further refinements to the HHS-RADV error rate calculation methodology beginning with the 2021 <span class=\"match\">benefit</span> year.\n \n \n \n 8 \n  CMS (2022). 2023 <span class=\"match\">Benefit</span> Year Final HHS Risk Adjustment Model Coefficients. \n \n https://\n \n www.cms.gov/files/document/2023-<span class=\"match\">benefit</span>-year-final-h"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS-RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also includes proposed requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS- RADV. It also addresses HHS' authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS' Exchange standards and requirements; HHS' system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; proposed reconsideration standards for certification denials; proposed changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a proposal to publicly share aggregated, summary-level Quality Improvement Strategy (QIS) information on an annual basis; and proposed revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.","document_number":"2024-23103","html_url":"https://www.federalregister.gov/documents/2024/10/10/2024-23103/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2026-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-10-10/pdf/2024-23103.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-23103.pdf?1728072923","publication_date":"2024-10-10","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"starting with the 2024 <span class=\"match\">benefit</span> year. In <span class=\"match\">addition</span>, we approved a 25 percent reduction to 2023 <span class=\"match\">benefit</span> year HHS risk adjustment transfers in Alabama's individual market and a 10 percent reduction to 2023 <span class=\"match\">benefit</span> year HHS risk adjustment transfers in Alabama's small group market. We also finalized further refinements to the HHS-RADV error rate calculation methodology beginning with the 2021 <span class=\"match\">benefit</span> year.\n \n \n \n 8 \n  CMS (2022). 2023 <span class=\"match\">Benefit</span> Year Final HHS Risk Adjustment Model Coefficients. \n https://www.cms.gov/files/document/2023-<span class=\"match\">benefit</span>-year-final-hhs-"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment program, as well as 2025 user fee rates for issuers offering qualified health plans (QHPs) through federally facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file Federal income taxes to reconcile advance payments of the premium tax credit (APTC); non- standardized plan option limits in the FFEs and SBE-FPs and a related exceptions process; standardized plan options in the FFEs and SBE-FPs; special enrollment periods (SEPs); direct enrollment (DE) entities supporting Exchange applications and enrollments; the Insurance Affordability Program enrollment eligibility verification process; requirements for agents, brokers, web-brokers, and DE entities assisting Exchange consumers; network adequacy; public notice procedures for section 1332 waivers; prescription drug benefits; updates to the Consumer Operated and Oriented Plan (CO-OP) Program; and State flexibility on the effective date of coverage in the Basic Health Program (BHP).","document_number":"2024-07274","html_url":"https://www.federalregister.gov/documents/2024/04/15/2024-07274/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2025","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-15/pdf/2024-07274.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07274.pdf?1712351231","publication_date":"2024-04-15","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"Curtin, (301) 492-4400, for matters <span class=\"match\">related</span> to the monthly 150 percent Federal poverty level special enrollment period. \n Alexandra Gribbin, (667) 290-9977, for matters <span class=\"match\">related</span> to dental coverage. \n Nikolas Berkobien, (667) 290-9903, for matters <span class=\"match\">related</span> to standardized plan options and non-standardized plan option limits. \n LeAnn Brodhead, (667) 290-8805, for matters <span class=\"match\">related</span> to the essential health <span class=\"match\">benefits</span> prescription drug <span class=\"match\">benefit</span>. \n Carolyn Sabini, (667) 290-9750, for matters <span class=\"match\">related</span> to the essential health <span class=\"match\">benefits</span> benchmark plan policy. \n Ken Buerger"},{"title":"Short-Term, Limited-Duration Insurance and Independent, Noncoordinated Excepted Benefits Coverage","type":"Rule","abstract":"This document sets forth final rules that amend the definition of short-term, limited-duration insurance, which is excluded from the definition of individual health insurance coverage under the Public Health Service Act. This document also sets forth final rules that amend the regulations regarding the requirements for hospital indemnity or other fixed indemnity insurance to be considered an excepted benefit in the group and individual health insurance markets.","document_number":"2024-06551","html_url":"https://www.federalregister.gov/documents/2024/04/03/2024-06551/short-term-limited-duration-insurance-and-independent-noncoordinated-excepted-benefits-coverage","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-03/pdf/2024-06551.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-06551.pdf?1711629917","publication_date":"2024-04-03","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"Internal Revenue Service","name":"Internal Revenue Service","id":254,"url":"https://www.federalregister.gov/agencies/internal-revenue-service","json_url":"https://www.federalregister.gov/api/v1/agencies/254","parent_id":497,"slug":"internal-revenue-service"},{"raw_name":"DEPARTMENT OF LABOR","name":"Labor Department","id":271,"url":"https://www.federalregister.gov/agencies/labor-department","json_url":"https://www.federalregister.gov/api/v1/agencies/271","parent_id":null,"slug":"labor-department"},{"raw_name":"Employee Benefits Security Administration","name":"Employee Benefits Security Administration","id":131,"url":"https://www.federalregister.gov/agencies/employee-benefits-security-administration","json_url":"https://www.federalregister.gov/api/v1/agencies/131","parent_id":271,"slug":"employee-benefits-security-administration"},{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"defined certain types of coverage as “excepted <span class=\"match\">benefits</span>” that were exempt from its portability requirements.\n 32 \n \n The same definitions are applied to describe <span class=\"match\">benefits</span> that are not required to comply with the ACA requirements.\n 33 \n \n There are four statutory categories of excepted <span class=\"match\">benefits</span>: independent, noncoordinated excepted <span class=\"match\">benefits</span>, which are the subject of these final rules; <span class=\"match\">benefits</span> that are excepted in all circumstances; \n 34 \n \n limited excepted <span class=\"match\">benefits</span>; \n 35 \n \n and supplemental excepted <span class=\"match\">benefits</span>.\n 36 \n \n \n \n \n 32 \n  \n See \n sections 9831(b)-(c)"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2025; Updating Section 1332 Waiver Public Notice Procedures; Medicaid; Consumer Operated and Oriented Plan (CO-OP) Program; and Basic Health Program","type":"Proposed Rule","abstract":"This proposed rule includes payment parameters and provisions related to the HHS-operated risk adjustment program, as well as 2025 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also includes proposed requirements related to the auto re-enrollment hierarchy; essential health benefits; failure to file and reconcile; non-standardized plan option limits and an exceptions process; standardized plan options; special enrollment periods (SEPs); direct enrollment (DE) entities; Insurance Affordability Program enrollment eligibility verification process; requirements for agents, brokers, web-brokers, and DE entities assisting Exchange consumers; network adequacy; public notice procedures for section 1332 waivers; prescription drug benefits; updates to the Consumer Operated and Oriented Plan (CO-OP) Program; State flexibility on the financial methodology used for Medicaid eligibility determinations for non- modified adjusted gross income (MAGI) populations; and State flexibility on the effective date of coverage in the Basic Health Program (BHP). A summary of this proposed rule may be found at https:// www.regulations.gov/.","document_number":"2023-25576","html_url":"https://www.federalregister.gov/documents/2023/11/24/2023-25576/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2025","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-11-24/pdf/2023-25576.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-25576.pdf?1700169608","publication_date":"2023-11-24","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"essential health <span class=\"match\">benefits</span> prescription drug <span class=\"match\">benefit</span>. \n Carolyn Sabini, (667) 290-9750, for matters <span class=\"match\">related</span> to the essential health <span class=\"match\">benefits</span> benchmark plan policy. \n Agata Pelka, (667) 290-9979, for matters <span class=\"match\">related</span> to mandates in <span class=\"match\">addition</span> to the essential health <span class=\"match\">benefits</span>. \n Emily Martin, (301) 492-4423, or Deborah Hunter, (443) 386-3651, for matters <span class=\"match\">related</span> to network adequacy and ECPs. \n Shilpa Gogna, (301) 492-4257, or Jenny Chen, (301) 492-5156, for matters <span class=\"match\">related</span> to approval of a State Exchange and State Exchange Blueprint requirements. \n Lina Rashid"},{"title":"Agency Information Collection Activities: Submission for OMB Review; Comment Request","type":"Notice","abstract":"The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.","document_number":"2024-02445","html_url":"https://www.federalregister.gov/documents/2024/02/07/2024-02445/agency-information-collection-activities-submission-for-omb-review-comment-request","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-07/pdf/2024-02445.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-02445.pdf?1707227119","publication_date":"2024-02-07","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"Statement to reflect that States are no longer required to annually notify HHS of any <span class=\"match\">State-required</span> <span class=\"match\">benefits</span> applicable to QHPs in the individual or small group market that are considered to be “in <span class=\"match\">addition</span> to EHB” or any <span class=\"match\">benefits</span> the State has identified as not in <span class=\"match\">addition</span> to EHB and not subject to <span class=\"match\">defrayal</span>. We also remove the forms State Annual Report on <span class=\"match\">State-Required</span> <span class=\"match\">Benefits</span> (Appendix G) and State Certification of Annual Report on <span class=\"match\">State-Required</span> <span class=\"match\">Benefits</span> (Appendix H) from this collection.\n \n \n This information collection also previously included"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also has requirements related to updating standardized plan options and reducing plan choice overload; the automatic re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers.","document_number":"2023-08368","html_url":"https://www.federalregister.gov/documents/2023/04/27/2023-08368/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2024","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-04-27/pdf/2023-08368.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-08368.pdf?1681935318","publication_date":"2023-04-27","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"with the 2024 <span class=\"match\">benefit</span> year. In <span class=\"match\">addition</span>, we approved a 25 percent reduction to 2023 <span class=\"match\">benefit</span> year transfers in Alabama's individual market and a 10 percent reduction to 2023 <span class=\"match\">benefit</span> year transfers in Alabama's small group market. We also finalized further refinements to the HHS–RADV error rate calculation methodology beginning with the 2021 <span class=\"match\">benefit</span> year and beyond.\n \n \n \n 8 \n  On May 6, 2022, we also published the \n 2023 <span class=\"match\">Benefit</span> Year Final HHS Risk Adjustment Model Coefficients \n at \n https://www.cms.gov/files/document/2023-<span class=\"match\">benefit</span>-year-final-hh"},{"title":"Agency Information Collection Activities: Proposed Collection; Comment Request","type":"Notice","abstract":"The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency's functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden.","document_number":"2023-21122","html_url":"https://www.federalregister.gov/documents/2023/09/27/2023-21122/agency-information-collection-activities-proposed-collection-comment-request","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-09-27/pdf/2023-21122.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-21122.pdf?1695732535","publication_date":"2023-09-27","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"Statement to reflect that States are no longer required to annually notify HHS of any <span class=\"match\">State-required</span> <span class=\"match\">benefits</span> applicable to QHPs in the individual or small group market that are considered to be “in <span class=\"match\">addition</span> to EHB” or any <span class=\"match\">benefits</span> the State has identified as not in <span class=\"match\">addition</span> to EHB and not subject to <span class=\"match\">defrayal</span>. We also remove the forms State Annual Report on <span class=\"match\">State-Required</span> <span class=\"match\">Benefits</span> (Appendix G) and State Certification of Annual Report on <span class=\"match\">State-Required</span> <span class=\"match\">Benefits</span> (Appendix H) from this collection.\n \n \n This information collection also previously included"},{"title":"PFAS National Primary Drinking Water Regulation","type":"Rule","abstract":"In March 2023, the U.S. Environmental Protection Agency (EPA) proposed and requested comment on the National Primary Drinking Water Regulation (NPDWR) and health-based Maximum Contaminant Level Goals (MCLGs) for six per- and polyfluoroalkyl substances (PFAS): perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), hexafluoropropylene oxide dimer acid (HFPO-DA, commonly known as GenX Chemicals), and perfluorobutane sulfonic acid (PFBS). After consideration of public comment and consistent with the provisions set forth under the Safe Drinking Water Act (SDWA), the EPA is finalizing NPDWRs for these six PFAS. Through this action, the EPA is finalizing MCLGs for PFOA and PFOS at zero. Considering feasibility, the EPA is promulgating individual Maximum Contaminant Levels (MCLs) for PFOA and PFOS at 4.0 nanograms per liter (ng/L) or parts per trillion (ppt). The EPA is also finalizing individual MCLGs and is promulgating individual MCLs for PFHxS, PFNA, and HFPO-DA at 10 ng/L. In addition to the individual MCLs for PFHxS, PFNA, and HFPO-DA, in consideration of the known toxic effects, dose additive health concerns and occurrence and likely co-occurrence in drinking water of these three PFAS, as well as PFBS, the EPA is finalizing a Hazard Index (HI) of 1 (unitless) as the MCLG and MCL for any mixture containing two or more of PFHxS, PFNA, HFPO-DA, and PFBS. Once fully implemented, the EPA estimates that the rule will prevent thousands of deaths and reduce tens of thousands of serious PFAS-attributable illnesses.","document_number":"2024-07773","html_url":"https://www.federalregister.gov/documents/2024/04/26/2024-07773/pfas-national-primary-drinking-water-regulation","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-04-26/pdf/2024-07773.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-07773.pdf?1714049126","publication_date":"2024-04-26","agencies":[{"raw_name":"ENVIRONMENTAL PROTECTION AGENCY","name":"Environmental Protection Agency","id":145,"url":"https://www.federalregister.gov/agencies/environmental-protection-agency","json_url":"https://www.federalregister.gov/api/v1/agencies/145","parent_id":null,"slug":"environmental-protection-agency"}],"excerpts":"Develop the Baseline Water System Characterization \n C. Overview of the Cost-<span class=\"match\">Benefit</span> Model \n D. Method for Estimating Costs \n E. Nonquantifiable Costs of the Final Rule \n F. Method for Estimating <span class=\"match\">Benefits</span> \n G. Nonquantifiable <span class=\"match\">Benefits</span> of PFOA and PFOS Exposure Reduction \n H. Nonquantifiable <span class=\"match\">Benefits</span> of Removal of PFAS Included in the Final Regulation and Co-Removed PFAS \n I. <span class=\"match\">Benefits</span> Resulting From Disinfection By-Product Co-Removal \n J. Comparison of Costs and <span class=\"match\">Benefits</span> \n K. Quantified Uncertainties in the Economic Analysis \n XIII. Statutory and"},{"title":"Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024","type":"Proposed Rule","abstract":"This proposed rule includes proposed payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as proposed 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This proposed rule also proposes requirements related to updating standardized plan options and reducing plan choice overload; re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers (ECPs) and network adequacy; failure to file and reconcile; special enrollment periods (SEPs); the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers.","document_number":"2022-27206","html_url":"https://www.federalregister.gov/documents/2022/12/21/2022-27206/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2024","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-12-21/pdf/2022-27206.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-27206.pdf?1671052525","publication_date":"2022-12-21","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"with the 2024 <span class=\"match\">benefit</span> year. In <span class=\"match\">addition</span>, we approved a 25 percent reduction to 2023 <span class=\"match\">benefit</span> year transfers in Alabama's individual market and a 10 percent reduction to 2023 <span class=\"match\">benefit</span> year transfers in Alabama's small group market. We also finalized further refinements to the HHS-RADV error rate calculation methodology beginning with the 2021 <span class=\"match\">benefit</span> year and beyond.\n \n \n \n 8 \n  On May 6, 2022, we also published the \n 2023 <span class=\"match\">Benefit</span> Year Final HHS Risk Adjustment Model Coefficients \n at \n https://www.cms.gov/files/document/2023-<span class=\"match\">benefit</span>-year-final-hh"},{"title":"Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program","type":"Rule","abstract":"This final rule will improve the electronic exchange of health care data and streamline processes related to prior authorization through new requirements for Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs). This final rule will also add new measures for eligible hospitals and critical access hospitals (CAHs) to report under the Medicare Promoting Interoperability Program and for MIPS eligible clinicians to report under the Promoting Interoperability performance category of the Merit-based Incentive Payment System (MIPS). These policies, taken together, will reduce overall payer and provider burden and improve patient access to health information while continuing CMS's drive toward interoperability in the health care market.","document_number":"2024-00895","html_url":"https://www.federalregister.gov/documents/2024/02/08/2024-00895/medicare-and-medicaid-programs-patient-protection-and-affordable-care-act-advancing-interoperability","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2024-02-08/pdf/2024-00895.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2024-00895.pdf?1705612517","publication_date":"2024-02-08","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"excerpts":"844-2883, for issues <span class=\"match\">related</span> to the data exchange policies generally, Patient Access API policies, or patient privacy. \n Scott Weinberg, (410) 786-6017, for issues <span class=\"match\">related</span> to the Provider Access API policies. \n Amy Gentile, (410) 786-3499, for issues <span class=\"match\">related</span> to Medicaid managed care. \n Kirsten Jensen, (410) 786-8146, for issues <span class=\"match\">related</span> to Medicaid FFS. \n Joshua Bougie, (410) 786-8117, for issues <span class=\"match\">related</span> to CHIP. \n Natalie Albright, (410) 786-1671, for issues <span class=\"match\">related</span> to MA organizations. \n Carolyn Kraemer, (301) 492-4197, for issues <span class=\"match\">related</span> to QHPs. \n Elizabeth"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023","type":"Rule","abstract":"This final rule includes payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as 2023 user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). This final rule also includes requirements related to guaranteed availability; the offering of QHP standardized plan options through Exchanges on the Federal platform; requirements for agents, brokers, and web-brokers; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; and re-enrollment. This final rule also responds to comments on how the Department of Health and Human Services (HHS) can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.","document_number":"2022-09438","html_url":"https://www.federalregister.gov/documents/2022/05/06/2022-09438/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2023","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-05-06/pdf/2022-09438.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-09438.pdf?1651522516","publication_date":"2022-05-06","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"matters <span class=\"match\">related</span> to cost-sharing reduction reconciliation. \n Josh Van Drei, (410) 786-1659, for matters <span class=\"match\">related</span> to actuarial value. \n Becca Bucchieri, (301) 492-4341, Agata Pelka, (301) 492-4400, or Leigha Basini, (301) 492-4380, for matters <span class=\"match\">related</span> to nondiscrimination based on sexual orientation and gender identity, essential health <span class=\"match\">benefit</span> benchmark plans, and <span class=\"match\">defrayal</span> of <span class=\"match\">State-required</span> <span class=\"match\">benefits</span>. \n Marisa Beatley, (301) 492-4307, for matters <span class=\"match\">related</span> to employer sponsored coverage verification. \n Susan Kalmus, (301) 492-4275, for matters <span class=\"match\">related</span> to"},{"title":"National Primary Drinking Water Regulations for Lead and Copper: Improvements (LCRI)","type":"Proposed Rule","abstract":"The U.S. Environmental Protection Agency (EPA) is proposing revisions to the National Primary Drinking Water Regulation (NPDWR) for lead and copper under the authority of the Safe Drinking Water Act (SDWA). In this document, EPA is proposing to require water systems to replace lead service lines, remove the lead trigger level, reduce the lead action level to 0.010 mg/L, and strengthen tap sampling procedures, among other changes that would improve public health protection and simplify the rule relative to the 2021 Lead and Copper Rule Revisions (LCRR). This proposed rule provides improvements in the additional following areas: corrosion control treatment, public education and consumer awareness, requirements for small systems, and sampling in schools and child care facilities. EPA's proposed rule aims to address potential disproportionate impacts of lead in drinking water in communities, including through proposed lead service line replacement and public education, among other areas of the proposed rule.","document_number":"2023-26148","html_url":"https://www.federalregister.gov/documents/2023/12/06/2023-26148/national-primary-drinking-water-regulations-for-lead-and-copper-improvements-lcri","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2023-12-06/pdf/2023-26148.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2023-26148.pdf?1701783917","publication_date":"2023-12-06","agencies":[{"raw_name":"ENVIRONMENTAL PROTECTION AGENCY","name":"Environmental Protection Agency","id":145,"url":"https://www.federalregister.gov/agencies/environmental-protection-agency","json_url":"https://www.federalregister.gov/api/v1/agencies/145","parent_id":null,"slug":"environmental-protection-agency"}],"excerpts":"Cost-<span class=\"match\">Benefit</span> Model \n C. Cost Analysis \n 1. Drinking Water System Costs \n 2. Annualized per Household Costs \n 3. State Costs \n 4. Costs Impacts Associated With Additional Phosphate Usage \n D. <span class=\"match\">Benefits</span> Analysis \n 1. Modeled Drinking Water Lead Concentrations \n 2. Blood Lead Modeling \n 3. Estimating Blood Lead Levels in Children (0-7 Year Olds) \n 4. Estimating Older Child and Adult Blood Lead Levels \n 5. Quantifying and Monetizing Health Endpoints \n 6. Estimating IQ <span class=\"match\">Benefits</span> \n 7. Estimated ADHD <span class=\"match\">Benefits</span> \n 8. Estimated Low Birth Weight <span class=\"match\">Benefits</span> \n 9."},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023","type":"Proposed Rule","abstract":"This proposed rule includes proposed payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as proposed 2023 user fee rates for issuers offering qualified health plans (QHPs) through federally- facilitated Exchanges and State-based Exchanges on the Federal platform. This proposed rule also proposes requirements related to prohibiting discrimination based on sexual orientation and gender identity; guaranteed availability; the offering of QHP standardized options through Exchanges on the Federal platform; requirements for agents, brokers, web-brokers, and issuers assisting consumers with enrollment through Exchanges that use the Federal platform; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits (EHBs); Actuarial Value (AV); QHP issuer quality improvement strategies; accounting for quality improvement activity (QIA) expenses and provider incentives for medical loss ratio (MLR) reporting and rebate calculation purposes; re-enrollment, and requirements related to a new State Exchange improper payment measurement program. This proposed rule also seeks comment on how HHS can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.","document_number":"2021-28317","html_url":"https://www.federalregister.gov/documents/2022/01/05/2021-28317/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2023","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-01-05/pdf/2021-28317.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2021-28317.pdf?1640726125","publication_date":"2022-01-05","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"Franz, (410) 786- 8027, or Hi'ilei Haru, 301-492-4363, for matters <span class=\"match\">related</span> to cost-sharing reduction reconciliation. \n Josh Van Drei, (410) 786-1659, for matters <span class=\"match\">related</span> to actuarial value (AV). \n Becca Bucchieri, (301) 492-4341, for matters <span class=\"match\">related</span> to essential health <span class=\"match\">benefit</span> (EHB)-benchmark plans and <span class=\"match\">defrayal</span> of <span class=\"match\">state-required</span> <span class=\"match\">benefits</span>. \n Marisa Beatley, (301) 492-4307, for matters <span class=\"match\">related</span> to employer sponsored coverage verification. \n Susan Kalmus, (301) 492-4275, for matters <span class=\"match\">related</span> to agent, broker, and web-broker guidelines. Dena Nelson, 240-401-3535"},{"title":"Medicare Program; Contract Year 2023 Policy and Technical Changes to the Medicare Advantage and Medicare Prescription Drug Benefit Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency; Additional Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency","type":"Rule","abstract":"This final rule will revise the Medicare Advantage (MA) (Part C) program and Medicare Prescription Drug Benefit (Part D) program regulations to implement changes related to marketing and communications, past performance, Star Ratings, network adequacy, medical loss ratio reporting, special requirements during disasters or public emergencies, and pharmacy price concessions. This final rule will also revise regulations related to dual eligible special needs plans (D-SNPs), other special needs plans, and cost contract plans. This final rule finalizes certain 2021 and 2022 Star Ratings provisions that were included in two interim final rules with comment period (IFC) that CMS issued on April 6, 2020, and September 2, 2020; other policies from those interim final rules will be addressed in other rulemakings.","document_number":"2022-09375","html_url":"https://www.federalregister.gov/documents/2022/05/09/2022-09375/medicare-program-contract-year-2023-policy-and-technical-changes-to-the-medicare-advantage-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2022-05-09/pdf/2022-09375.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2022-09375.pdf?1651263314","publication_date":"2022-05-09","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"}],"excerpts":"this provision would allow the necessary distinctions in communications and enrollee materials describing access to Medicaid <span class=\"match\">benefits</span> for partial-<span class=\"match\">benefit</span> dually eligible enrollees compared to full-<span class=\"match\">benefit</span> dually eligible enrollees. A few commenters noted that separate PBPs based on whether enrollees are eligible for partial Medicaid <span class=\"match\">benefits</span> or full Medicaid <span class=\"match\">benefits</span> allows for targeting supplemental <span class=\"match\">benefits</span> to partial-<span class=\"match\">benefit</span> dually eligible individuals, and a commenter indicated it could potentially lead to some financial incentives for States to"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards","type":"Rule","abstract":"This final rule sets forth payment parameters and provisions related to the risk adjustment program and cost-sharing parameters. It includes changes related to special enrollment periods; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; income verification by Exchanges; and other related topics. It also revises the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers.","document_number":"2021-09102","html_url":"https://www.federalregister.gov/documents/2021/05/05/2021-09102/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2022-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2021-05-05/pdf/2021-09102.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2021-09102.pdf?1619786726","publication_date":"2021-05-05","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"155. \n Katherine Bentley, (301) 492-5209, for matters <span class=\"match\">related</span> to special enrollment period verification. \n Rebecca Bucchieri, (301) 492-4400, for matters <span class=\"match\">related</span> to EHB-benchmark plans and <span class=\"match\">defrayal</span> of <span class=\"match\">state-required</span> <span class=\"match\">benefits</span>. \n Aaron Franz, (410) 786-8027, for matters <span class=\"match\">related</span> to user fees. \n Joshua Paul, (301) 492-4347 or Nora Simmons, (410-786-1981), for matters <span class=\"match\">related</span> to the premium adjustment percentage. \n Ken Buerger, (410) 786-1190, for matters <span class=\"match\">related</span> to PBM transparency reporting requirements. \n Nora Simmons, (410-786-1981), Adrianne Carter"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates To State Innovation Waiver (Section 1332 Waiver) Implementing Regulations","type":"Proposed Rule","abstract":"This proposed rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally- facilitated Exchanges and State-based Exchanges on the Federal platform. It includes proposed changes related to special enrollment periods; Navigator program standards; direct enrollment entities; the administrative appeals processes with respect to health insurance issuers and non-federal governmental group health plans; the medical loss ratio program; acceptance of payments by issuers of individual market Qualified Health Plans; and other related topics. It proposes clarifications to the regulation imposing network adequacy standards with regard to Qualified Health Plans that do not use provider networks. It proposes changes to the regulation requiring the reporting of certain prescription drug information by qualified health plans or their pharmacy benefit managers. It also proposes a new direct enrollment option for Federally-facilitated Exchanges and State Exchanges. This proposed rule also proposes changes related to section 1332 State Innovation Waivers.","document_number":"2020-26534","html_url":"https://www.federalregister.gov/documents/2020/12/04/2020-26534/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2022-and","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2020-12-04/pdf/2020-26534.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2020-26534.pdf?1606775426","publication_date":"2020-12-04","agencies":[{"raw_name":"DEPARTMENT OF THE TREASURY","name":"Treasury Department","id":497,"url":"https://www.federalregister.gov/agencies/treasury-department","json_url":"https://www.federalregister.gov/api/v1/agencies/497","parent_id":null,"slug":"treasury-department"},{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"matters <span class=\"match\">related</span> to special enrollment periods for Exchange enrollment under part 155. \n Katherine Bentley, (301) 492-5209, for matters <span class=\"match\">related</span> to special enrollment period verification. \n Ken Buerger, (410) 786-1190, for matters <span class=\"match\">related</span> to EHB-benchmark plans, <span class=\"match\">defrayal</span> of <span class=\"match\">state-required</span> <span class=\"match\">benefits</span>, network adequacy standards, and PBM transparency reporting requirements. \n Joshua Paul, (301) 492-4347, for matters <span class=\"match\">related</span> to the premium adjustment percentage. \n Adrianne Carter, (303) 844-5810, or Amber Bellsdale, (301) 492-4411, for matters <span class=\"match\">related</span> to disputes"},{"title":"Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2021; Notice Requirement for Non-Federal Governmental Plans","type":"Rule","abstract":"This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also finalizes changes related to essential health benefits and will provide states with additional flexibility in the operation and establishment of Exchanges. The rule includes changes related to cost sharing for prescription drugs; notice requirements for excepted benefit health reimbursement arrangements offered by non- Federal governmental plan sponsors; Exchange eligibility and enrollment; exemptions from the requirement to maintain coverage; quality rating information display standards for Exchanges; and other related topics. This final rule also repeals regulations relating to the Early Retiree Reinsurance Program.","document_number":"2020-10045","html_url":"https://www.federalregister.gov/documents/2020/05/14/2020-10045/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2021","pdf_url":"https://www.govinfo.gov/content/pkg/FR-2020-05-14/pdf/2020-10045.pdf","public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2020-10045.pdf?1588882536","publication_date":"2020-05-14","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"}],"excerpts":"collections reports. \n Rebecca Zimmermann, (301) 492-4396, for matters <span class=\"match\">related</span> to value-based insurance plan design. \n Becca Bucchieri, (301) 492-4341, for matters <span class=\"match\">related</span> to essential health <span class=\"match\">benefit</span> (EHB)-benchmark plans and <span class=\"match\">defrayal</span> of <span class=\"match\">state-required</span> <span class=\"match\">benefits</span>. \n Jill Gotts, (202) 603-0480, for matters <span class=\"match\">related</span> to eligibility appeals. \n Emily Ames, (301) 492-4246, for matters <span class=\"match\">related</span> to coverage effective dates and termination notices. \n Marisa Beatley, (301) 492-4307, for matters <span class=\"match\">related</span> to employer-sponsored coverage verification and periodic data matching"}]}