United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2014_register executive 2014-03-11 article Part II Rules and Regulations D09002ee1c7fa5654 D09002ee1c7fa5755 United States Department of Health and Human Services originator org United States Government Agency or Subagency This final rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards with respect to composite premiums, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program. 79 FR 13744 https://www.govinfo.gov/app/details/FR-2014-03-11/2014-05052 2014-05052 fr11mr14-23 RIN 0938-AR89 4120-01-P CMS-9954-F https://www.govinfo.gov/app/details/FR-2014-03-11/2014-05052 https://www.govinfo.gov/content/pkg/FR-2014-03-11/html/2014-05052.htm https://www.govinfo.gov/content/pkg/FR-2014-03-11/pdf/2014-05052.pdf Health Care Health Insurance Reporting and Recordkeeping Requirements State Regulation of Health Insurance Administrative Practice and Procedure Adverse Selection Health Records Organization and Functions (Government Agencies) Premium Stabilization Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Health Care Access Cost-Sharing Reductions Advance Payments of Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Administrative Appeals Administration and Calculation of Advance Payments of Premium Tax Credit Advertising Advisory Committees Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals American Indian/Alaska Natives Individuals with Disabilities Loan Programs-Health Medicaid Payment and Collections Reports Public Assistance Programs Sunshine Act Technical Assistance Women Youth Claims Health Plans Penalties Premium Revenues Medical Loss Ratio Rebating 100 p. 13744 13843 79 FR 13744 Title 45 Part 144 45 CFR Part 144 Title 45 Part 147 45 CFR Part 147 Title 45 Part 153 45 CFR Part 153 Title 45 Part 155 45 CFR Part 155 Title 45 Part 156 45 CFR Part 156 Title 45 Part 158 45 CFR Part 158 RIN 0938-AR89 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015; Federal Register Vol. 79, Issue RULE 2014-05052 II DEPARTMENT OF HEALTH AND HUMAN SERVICES 2014-05-12 CMS-9954-F 4120-01-P 2014-05052 Final rule.

This final rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional standards with respect to composite premiums, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.

These regulations are effective on May 12, 2014. For general information: Sharon Arnold, (301) 492-4286; Laurie McWright, (301) 492-4311; or Jeff Wu, (301) 492-4305. For matters related to student health insurance coverage and composite premiums: Jacob Ackerman, (301) 492-4179. For matters related to the risk adjustment program: Kelly Horney, (410) 786-0558. For general matters related to the reinsurance program: Adrianne Glasgow, (410) 786-0686. For matters related to reinsurance contributions: Adam Shaw, (410) 786- 1019. For matters related to risk corridors: Jaya Ghildiyal, (301) 492-5149. For matters related to medical loss ratio: Christina Pavlus, (301) 492- 4172. For matters related to cost-sharing reductions and netting of payments and charges: Pat Meisol, (410) 786-1917. For matters related to the premium adjustment percentage: Johanna Lauer, (301) 492-4397. For matters related to Federally-facilitated Exchange user fees: Michael Cohen, (301) 492-4277. For matters related to the annual limitation on cost sharing for stand- alone dental plans, privacy and security of personally identifiable information, the annual open enrollment period for 2015, and the meaningful difference standard: Leigha Basini, (301) 492-4380. For matters related to the Small Business Health Options Program: Christelle Jang, (410) 786-8438. For matters related to the actuarial value calculator: Allison Yadsko, (410) 786-1740. For matters related to patient safety standards for issuers of qualified health plans: Nidhi Singh Shah, (301) 492-5110. Health Care Health Insurance Reporting and Recordkeeping Requirements State Regulation of Health Insurance Administrative Practice and Procedure Adverse Selection Health Records Organization and Functions (Government Agencies) Premium Stabilization Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Health Care Access Cost-Sharing Reductions Advance Payments of Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Administrative Appeals Administration and Calculation of Advance Payments of Premium Tax Credit Advertising Advisory Committees Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals American Indian/Alaska Natives Individuals with Disabilities Loan Programs-Health Medicaid Payment and Collections Reports Public Assistance Programs Sunshine Act Technical Assistance Women Youth Claims Health Plans Penalties Premium Revenues Medical Loss Ratio Rebating Patient Protection and Affordable Care Act: Benefit and Payment Parameters for 2015 , actuarialvalue@cms.hhs.gov OIRA_submission@omb.eop.gov Paperwork@cms.hhs.gov HealthCare.gov http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://pcaobus.org/Standards/Auditing/Pages/default.aspx http://www.aicpa.org/Research/Standards/AuditAttest/Pages/SAS.aspx http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2014-02-ACAtables.pdf http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs18.html http://www.cms.gov/CCIIO/Resources/Files/Downloads/opt_out_memo.pdf http://www.cms.gov/CCIIO/Resources/Letters/Downloads/commissioner-letter-11-14-2013.PDF http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014_letter_to_issuers_04052013.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/mec-guidance-10-31-2013.pdf http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html#MinimumAcceptableRiskStandards http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2012.pdf http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsMethodology2012.pdf http://www.dol.gov/ebsa/faqs/faq-aca18.html http://www.dol.gov/ebsa/pdf/2013-5500inst.pdf http://www.gao.gov/yellowbook http://www.irs.gov/pub/irs-drop/rp-13-25.pdf http://www.nadp.org/Libraries/HCR_Documents/phsa027.sflb.ashx http://www.rand.org/pubs/reports/R3055 https://www.regtap.info/uploads/library/ACA_HHS_OperatedRADVWhitePaper_062213_5CR_062213.pdf https://www.regtap.info/uploads/library/HHS_OperatedDataCollectionPolicyFAQs_062613 Vol. 79, no. 47 Office of the Federal Register, National Archives and Records Administration 2014-03-11 continuing daily deposited born digital 384 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2014-03-11 P0b002ee187baa568 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr11mr14 https://www.govinfo.gov/app/details/FR-2014-03-11 https://www.govinfo.gov/content/pkg/FR-2014-03-11/pdf/FR-2014-03-11.pdf https://www.govinfo.gov/content/pkg/FR-2014-03-11/xml/FR-2014-03-11.xml fdlp 13497 13871 DGPO 2014-03-11 2024-06-03 FR-2014-03-11 machine generated eng FR FR-2014-03-11 79 47