Final Rule: PPACA, HHS Notice of Benefit and Payment Parameters for 2024, 45 CFR Parts 153, 155 and 156, 88 Fed. Reg. 25740 (Apr. 27, 2023); Fact Sheet: HHS Notice of Benefit and Payment Parameters for 2024 Final Rule (Apr. 17, 2023)
HHS has finalized regulations that amend and refine several benefit payment parameters and other Affordable Care Act (ACA) insurance market and Exchange related rules for 2024. Most provisions are aimed specifically at insurers and Exchange regulators. Here are highlights:
Midyear Terminations of Exchange Coverage for Dependent Children. Based on the ACA requirement that group health plans and insurers that offer coverage to dependent children allow the children to stay on their parents’ plans until age 26, federally facilitated Exchanges have operationally required insurers to maintain coverage of dependent children until the end of the plan year in which they turn 26 (even though this was not required under the age 26 rules). Formalizing this requirement for federally facilitated Exchanges, the regulations prohibit midyear terminations of coverage for dependent children who reach the maximum age limit under the ACA or state law (unless termination is otherwise permitted). The requirement is optional for state-based Exchanges.
Exchange Enrollment Periods. Beginning in 2024, Exchanges have the option to implement a special enrollment rule for individuals losing Medicaid or Children’s Health Insurance Program (CHIP) coverage that is also considered minimum essential coverage. Under the special rule, individuals have 60 days before, or 90 days after, a loss of such coverage to select an Exchange plan. State-based Exchanges may allow more time and may implement the rule before 2024. In another finalized special enrollment rule, Exchanges may offer earlier coverage effective dates for certain individuals attesting to a future loss of minimum essential coverage. Revisions also clarify that only one person in a household applying for coverage through the Exchange must qualify for a special enrollment period for the entire household to qualify.
EBIA Comment: These regulations address various Exchange and insurance market rules of interest to insurers and Exchanges (e.g., revised rules on network adequacy and new requirements related to agents and brokers) that employers and their health plan advisors will want to review for indirect impacts on their health plans. In the past, HHS announced the annual limitation on cost-sharing for a given benefit year in the notice of benefit and payment parameters for that year, but starting with the 2023 benefit year, the maximum annual limitation on cost-sharing (and certain other limits) will be published in separate guidance, so long as no changes to the methods for calculating these amounts are proposed. HHS has already issued the limits for the 2024 benefit year (see our Checkpoint article). For more information, see EBIA’s Health Care Reform manual at Sections XI.B (“Requirement to Extend Coverage to Children Under Age 26”) and XXI.A.3 (“Annual and Special Enrollment Periods Required for Exchanges”).
Contributing Editors: EBIA Staff.