Data / Federal rules / 2024-23103
Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2026; and Basic Health Program
The Centers for Medicare & Medicaid Services published this proposed rule in the Federal Register on October 10, 2024. Comments closed on November 12, 2024.
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What the agency says
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.
Key facts
- Document number
- 2024-23103
- Type
- Proposed rule
- Action
- Proposed rule
- Agency
- Health and Human Services Department; Centers for Medicare & Medicaid Services
- Published
- October 10, 2024
- Comments due
- November 12, 2024
- Dates
- To be assured consideration, comments must be received at one of the addresses provided below, by November 12, 2024.
- Docket
- CMS-9888-P
- Regulation ID (RIN)
- 0938-AV41
- Code of Federal Regulations
- 42 CFR 600; 45 CFR 153; 45 CFR 155; 45 CFR 156; 45 CFR 158
- Topics
- Administrative practice and procedure; Advertising; Advisory committees; Brokers; Claims; Consumer protection; Grant programs-health; Health care; Health insurance; Health maintenance organizations (HMO); Health records; Hospitals; Indians; Individuals with disabilities; Intergovernmental relations; Loan programs-health; Medicaid; Organization and functions (Government agencies); Penalties; Public assistance programs; Reporting and recordkeeping requirements; State and local governments; Sunshine Act; Technical assistance; Women; Youth
- Pages
- 104
Other documents from the Centers for Medicare & Medicaid Services
Everything from the Centers for Medicare & Medicaid Services · Rules on administrative practice and procedure · Rules on advertising · Rules on advisory committees · Published in October 2024
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