CMS NEWS
FOR IMMEDIATE RELEASE
February 20, 2015
Contact: CMS Media Relations
(202) 690-6145 | press@cms.hhs.gov
CMS issues thefinal HHS
Notice of Benefit and Payment Parameters for 2016
Stronger standards for
issuers and Marketplaces
The Centers for Medicare & Medicaid Services (CMS) has issued
the Final HHS Notice of Benefit and Payment Parameters for 2016. This rule
seeks to improve consumers’ experience in the Health Insurance Marketplace and
to ensure their coverage options are affordable and accessible. This rule
builds on previously issued standards which seek to make high-quality health
insurance available to all Americans. The final notice further strengthens
transparency, accountability, and the availability of information for consumers
about their health plans.
“We work every day to strengthen programs that deliver quality,
affordable care to families across the country,” said CMS Administrator Marilyn
Tavenner. “CMS is working to improve the consumer experience and promote
accountability, uniformity, and transparency in private health insurance.”
The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run
through January 31, 2016, giving consumers three full months to shop. To further aid consumers in finding a health plan that best
suits their needs, the rule clarifies standards for qualified health plan (QHP)
issuers to publish up-to-date, accurate, and complete provider directories and
formularies. Issuers also must make this information available in standard, machine-readable
formats.
To enhance the transparency of the rate-setting process, the final
rule includes provisions to facilitate public access to information about rate
increases in the individual and small group markets for both QHPs and non-QHPs
using a uniform timeline. It also includes provisions to further protect
consumers against unreasonable rate increases by ensuring more rates are
subject to review.
To
ensure consumers have access to high-quality, affordable health insurance,
premium stabilization programs were put in place to promote price stability for
health insurance in the individual and small group markets. This rule includes
additional provisions and modifications related to the implementation of these
programs, as well as the key payment parameters for the 2016 benefit year.
Additionally, the rule will help consumers access the medications
they need by improving the process by which an enrollee can request access to
medications not included on a plan’s formulary. The rule provides more detailed
procedures for the standard exception process, and adds a requirement for an
external review of an exception request if the health plan denies the initial
request. It also clarifies that cost-sharing for drugs obtained through the
exceptions process must count toward the annual limitation on cost sharing of a
plan subject to the essential health benefits requirement. The rule also
ensures that issuers’ formularies are developed based on expert
recommendations.
The rule improves meaningful access standards by requiring that
all Marketplaces, QHP issuers, and web brokers provide telephonic interpreter
services in at least 150 languages in addition to the existing requirements
regarding the provision of oral interpretation services, and strengthens other
requirements related to language access.
To enhance the consumer experience for the Small Business Health
Options Program (SHOP), the rule seeks to streamline the administration of
group coverage provided through SHOP and to align SHOP regulations with
existing market practices.
The
final rule was placed on display at the Federal Register today, and can be
found at:
CMS also released its final annual letter to issuer, which
provides additional guidance on these and related standards for plans
participating in the Federally-facilitated Marketplace. The letter is available
here: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2016_Letter_to_Issuers_2_20_2015.pdf
Payment
Parameters Fact sheet: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/2016-PN-Fact-Sheet-final.pdf
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