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Benefits

HHS Proposes to Amend and Repeal Various Benefit and Payment Parameters and Provisions for 2022 and Beyond

EBIA  

EBIA  

PPACA; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond; Proposed Rule, 45 CFR Parts 147, 155, 156, 86 Fed. Reg. 35156 (July 1, 2021)

Available at https://www.govinfo.gov/content/pkg/FR-2021-07-01/pdf/2021-13993.pdf

HHS has proposed another round of regulations that would amend and repeal an assortment of benefit and payment parameters and other Affordable Care Act (ACA) insurance market and Exchange-related rules. Although largely aimed at insurers and Exchange regulators, some provisions may be of interest to employers and their advisors. Here are highlights:

  • Expanded Exchange Enrollment Periods. Starting with the 2022 coverage year, HHS proposes to lengthen the Exchange annual open enrollment period (which also applies to non-grandfathered plans in the individual market outside the Exchange) to November 1 through January 15. (The current annual open enrollment period is November 1 through December 15.) A proposal would establish a new monthly special enrollment period on the federal Exchange for individuals eligible for advance payment of the premium tax credit whose household income does not exceed 150% of the federal poverty level. (State Exchanges also may adopt the monthly special enrollment period.)
  • Repealed Exchange Direct Enrollment Option. Another proposal would repeal the Exchange direct enrollment option, which establishes a process for Exchanges to work directly with insurers, agents, and brokers to operate enrollment websites through which consumers can apply for coverage, receive an eligibility determination, and purchase a plan (see our Checkpoint article).
  • Amended State Innovation Waiver Rules. HHS proposes to modify regulations and policies related to Section 1332 innovation waivers, many of which were recently finalized in Part One of the 2022 benefit and payment parameters (see our Checkpoint article). Among other things, the proposal would 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. A proposed technical amendment to the ACA essential health benefit (EHB) requirements would make clear 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: The proposals largely reflect differences between the Trump and Biden administrations’ views of the ACA. As always, these proposed regulations address a wide range of rules of interest to insurers and Exchanges, but employers and their health plan 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?”).

Contributing Editors: EBIA Staff.

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