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 2015_register executive 2015-02-27 article Part II Rules and Regulations D09002ee1c7f7e465 D09002ee1c7f7e551 United States Department of Health and Human Services originator org United States Government Agency or Subagency This final rule sets forth payment parameters and 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 finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics. 80 FR 10750 https://www.govinfo.gov/app/details/FR-2015-02-27/2015-03751 2015-03751 fr27fe15-16 RIN 0938-AS19 4120-01-P CMS-9944-F https://www.govinfo.gov/app/details/FR-2015-02-27/2015-03751 https://www.govinfo.gov/content/pkg/FR-2015-02-27/html/2015-03751.htm https://www.govinfo.gov/content/pkg/FR-2015-02-27/pdf/2015-03751.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 Claims Health Plans Penalties Health Care Access Required Contribution Percentage Cost-Sharing Reductions Advance Payments of the Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Administrative Appeals Advertising Advisory Committees American Indian/Alaska Natives Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals Individuals with Disabilities Loan Programs-Health Medicaid Payment and Collections Reports Public Assistance Programs Sunshine Act Technical Assistance Women Youth Medical Loss Ratio Premium Revenues Rebating Reporting and Recordkeeping Requirements 128 p. 10750 10877 80 FR 10750 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 154 45 CFR Part 154 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-AS19 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2016; Federal Register Vol. 80, Issue RULE 2015-03751 II DEPARTMENT OF HEALTH AND HUMAN SERVICES 2015-04-28 CMS-9944-F 4120-01-P 2015-03751 Final rule.

This final rule sets forth payment parameters and 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 finalizes additional standards for the individual market annual open enrollment period for the 2016 benefit year, essential health benefits, qualified health plans, network adequacy, quality improvement strategies, the Small Business Health Options Program, guaranteed availability, guaranteed renewability, minimum essential coverage, the rate review program, the medical loss ratio program, and other related topics.

These regulations are effective on April 28, 2015 except the amendments to Sec. Sec. 156.235, 156.285(d)(1)(ii), and 158.162 are effective on January 1, 2016. For general information: Jeff Wu, (301) 492-4305. 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 Claims Health Plans Penalties Health Care Access Required Contribution Percentage Cost-Sharing Reductions Advance Payments of the Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Administrative Appeals Advertising Advisory Committees American Indian/Alaska Natives Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals Individuals with Disabilities Loan Programs-Health Medicaid Payment and Collections Reports Public Assistance Programs Sunshine Act Technical Assistance Women Youth Medical Loss Ratio Premium Revenues Rebating Reporting and Recordkeeping Requirements Patient Protection and Affordable Care Act: Benefit and Payment Parameters , Paperwork@cms.hhs.gov HealthCare.gov http://bhpr.hrsa.gov/shortage/hpsas/certofeligibility.pdf http://bhpr.hrsa.gov/shortage/hpsas/ruralhealthhpsa.html http://bphc.hrsa.gov/about/lookalike/index.html http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://oig.hhs.gov/oei/reports/oei-05-10-00450.pdf http://www.bls.gov/ncs/ebs/sp/selmedbensreport.pdf http://www.cms.gov/CCIIO/Programs-and-Initiatives/Health-Insurance-Marketplaces/Downloads/Description-and-Purpose-of-Draft-HHS-List-of-ECPs-for-PY-2016_12-24-14.pdf http://www.cms.gov/cciio/programs-and-initiatives/health-insurance-marketplaces/qhp.html http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html http://www.cms.gov/CCIIO/Resources/Data-Resources/ehb.html#review http://www.cms.gov/CCIIO/Resources/Data-Resources/ratereview.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs13.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs18.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/faq-risk-corridors-04-11-2014.pdf http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/Reinsurance-contributions-process-FAQ-5-22-14.pdf http://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf http://www.cms.gov/CCIIO/Resources/Letters/Downloads/commissioner-letter-11-14-2013.PDF http://www.cms.gov/CCIIO/Resources/Letters/Downloads/letter-to-Francis.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2015-final-issuer-letter-3-14-2014.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/DIY-instructions-5-20-14.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Renewal-Notices-9-3-14-FINAL.PDF http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10448.html http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10448.html?DLPage=2&DLSort=1&DLSortDir=descending 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.cms.hhs.gov/PaperworkReductionActof1995 http://www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm111350.htm http://www.irs.gov/pub/irs-drop/n-14-69.pdf http://www.irs.gov/pub/irs-drop/rp-13-25.pdf http://www.naic.org/store/free/MDL-22.pdf http://www.politico.com/static/PPM170_100811_taxes.html http://www.rand.org/pubs/reports/R3055 http://www.regulations.gov https://www.cms.gov/CCIIO/Resources/Data-Resources/Downloads/ehb-rx-crosswalk.pdf https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/faq-risk-corridors-04-11-2014.pdf https://www.regtap.info/ https://www.regtap.info/faq_viewu.php?id=1212 https://www.regtap.info/uploads/library/APTC_CSR_Recon_timing_guidance_5CR_021315.pdf Pay.gov www.ada.gov www.pay.gov www.ratereview.healthcare.gov Vol. 80, no. 39 Office of the Federal Register, National Archives and Records Administration 2015-02-27 continuing daily deposited born digital 514 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2015-02-27 P0b002ee18b51e5c2 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr27fe15 https://www.govinfo.gov/app/details/FR-2015-02-27 https://www.govinfo.gov/content/pkg/FR-2015-02-27/pdf/FR-2015-02-27.pdf https://www.govinfo.gov/content/pkg/FR-2015-02-27/xml/FR-2015-02-27.xml fdlp 10569 11075 DGPO 2015-02-27 2024-06-02 FR-2015-02-27 machine generated eng FR FR-2015-02-27 80 39