HHS Publishes Final Notice of Benefit and Payment Parameters for 2016 Health Insurance Marketplaces > Hospital Association of Pennsylvania


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HHS Publishes Final Notice of Benefit and Payment Parameters for 2016 Health Insurance Marketplaces

February 23, 2015

The U.S. Department of Health and Human Services (HHS) issued its final notice of benefit and payment parameters for 2016, establishing key standards for issuers and marketplaces for 2016.

The notice includes payment parameters applicable to the 2016 benefit year, and proposes new standards to improve consumers’ experience and ensure coverage is affordable and accessible.

Key provisions of interest in the notice include:

  • The open enrollment period for non-grandfathered policies in the individual market, inside and outside the marketplace, for the 2016 benefit year will be from November 1, 2015, through January 31, 2016.
  • States may select new essential health benefits benchmark plans for 2017, based on plans available during 2014.
  • Health plans must publish an easily-accessible, up-to-date, accurate, and complete list of all covered drugs on its formulary drug list, including any tiering structure and any restrictions on the manner in which a drug can be obtained.
  • A qualified health plan issuer must publish an easily-accessible, up-to-date, accurate, and complete provider directory, including information about which providers are accepting new patients.
  • The standard for qualified health plan issuers used during 2015 for the federally-facilitated marketplaces—that issuers seeking qualified health plan certification in the federally-facilitated marketplaces subject to the general essential community provider standard will be required to offer provider contracts to at least one essential community provider in each essential community provider category (i.e., federally qualified health clinics, Ryan White providers, family planning providers, hospitals, and others) in each county in the service area, where a provider in that category is available—will be continued.
  • To obtain qualified health plan certification, each issuer must implement a quality improvement strategy—a payment structure that provides increased reimbursement or other incentives to improve health outcomes, reduce hospital readmissions, improve patient safety and reduce medical errors, implement wellness and health promotion activities, and reduce health and health care disparities.

The final rule also includes provisions to facilitate public access to information about rate increases in the individual and small group markets for both qualified health plans and non- qualified health plans using a uniform timeline.

In addition, it includes provisions to further protect consumers against unreasonable rate increases by ensuring more rates are subject to review.

Additional guidance about these and related standards for plans participating in the federally-facilitated marketplace can be found in the Centers for Medicare & Medicaid Services’ annual letter to issuers, and in the Payment Parameters fact sheet for 2016.

HAP will continue to provide member hospitals and health systems with updates related to the federally-facilitated health insurance marketplace.

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