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HHS Finalizes Various Benefit and Payment Parameters and Provisions for 2022 and Beyond


· 5 minute read


· 5 minute read

PPACA; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond; Final Rule, 31 CFR Part 33, 45 CFR Parts 147, 155, 156, 86 Fed. Reg. ___ (Sept. 27, 2021)

Final Rule

Fact Sheet

HHS has finalized regulations that amend various benefit and payment parameters and other Affordable Care Act (ACA) insurance market and Exchange-related rules. The final regulations adopt the rules proposed in July (see our Checkpoint article) without significant changes. Here are highlights:

  • Expanded Exchange Enrollment Periods. Starting with the 2022 coverage year, the annual open enrollment period for individual coverage on the federal Exchange platform will be November 1 through January 15—extended from the current end date of December 15. (State Exchanges not using the federal platform may choose a different end date no earlier than December 15.) The regulations adopt the proposed monthly federal Exchange special enrollment periods for individuals whose household income does not exceed 150% of the federal poverty level, but limit special enrollments to periods when the individuals’ “applicable percentage” is zero for purposes of calculating the ACA’s premium tax credits. (State Exchanges also may adopt the monthly special enrollment period.) The regulations specify permitted coverage changes in this situation and describe the required effective dates of coverage under the modified enrollment periods.
  • Exchange Direct Enrollment. Repeal of the Exchange direct enrollment option is finalized.
  • Amended State Innovation Waiver Rules. HHS adopts the proposed changes to the regulations and policies related to Section 1332 innovation waivers, with minor clarifications. Among other things, the final regulations supersede and rescind the policies and interpretations in the 2018 State Relief and Empowerment Waivers guidance, which provided more flexibility for states to apply for waivers from certain ACA provisions (see our Checkpoint article).
  • Technical Amendment for Mental Health Parity. The regulations finalize a technical amendment to the ACA essential health benefit (EHB) requirements clarifying that health plans required to cover EHB must comply with the requirements of the Mental Health Parity and Addiction Equity Act (MHPAEA), including any amendments.

EBIA Comment: Although these regulations are primarily of interest to insurers and Exchanges, health plan sponsors and their advisors will want to review them for indirect impacts on their health plans. For more information, see EBIA’s Health Care Reform manual at Sections XIV.F (“Comprehensive Health Coverage Requirement (Essential Health Benefits Package)—Applicable Only in the Individual and Small Group Markets”), XXI.A.3 (“Annual and Special Enrollment Periods Required for Exchanges”), XXI.F (“Innovation Waivers”), and XXI.G (“Premium Tax Credits”). See also EBIA’s Group Health Plan Mandates manual at Section IX.A (“What Is Mental Health Parity and Who Must Comply?”). You may also be interested in our upcoming webinar “Group Health Plans Quarterly Update: Q3 2021” (live on 9/29/2021).

Contributing Editors: EBIA Staff.

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