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 2016_register executive 2016-12-21 article Part III Rules and Regulations D09002ee1c7f30d51 D09002ee1c7f30e4b 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 program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics. 81 FR 94058 https://www.govinfo.gov/app/details/FR-2016-12-22/2016-30433 2016-30433 fr22de16-19 RIN 0938-AS95 RIN 0938-AS87 4120-01-P CMS-9934-F CMS-9933-F https://www.govinfo.gov/app/details/FR-2016-12-22/2016-30433 https://www.govinfo.gov/content/pkg/FR-2016-12-22/html/2016-30433.htm https://www.govinfo.gov/content/pkg/FR-2016-12-22/pdf/2016-30433.pdf Health Care Health Insurance Reporting and Recordkeeping Requirements Administrative Practice and Procedure Penalties Health Records Organization and Functions (Government Agencies) Claims Advertising Brokers Conflict of Interest Consumer Protection Grant Administration Grant Programs-Health Health Maintenance Organizations (Hmo) Hospitals Indians Individuals with Disabilities Intergovernmental Relations Loan Programs-Health Medicaid Public Assistance Programs Technical Assistance Women and Youth American Indian/Alaska Natives Cost-Sharing Reductions Grants Administration Health Maintenance Organization (Hmo) State and Local Governments Sunshine Act Women Youth Employee Benefit Plans 126 p. 94058 94183 81 FR 94058 Title 45 Part 144 45 CFR Part 144 Title 45 Part 146 45 CFR Part 146 Title 45 Part 147 45 CFR Part 147 Title 45 Part 148 45 CFR Part 148 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 157 45 CFR Part 157 Title 45 Part 158 45 CFR Part 158 RIN 0938-AS95 RIN 0938-AS87 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program; Federal Register Vol. 81, Issue RULE 2016-30433 III DEPARTMENT OF HEALTH AND HUMAN SERVICES 2017-01-17 CMS-9934-F CMS-9933-F 4120-01-P 2016-30433 Final rule.

This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics.

These regulations are effective January 17, 2017. Jeff Wu, (301) 492-4305, Lindsey Murtagh, (301) 492-4106, or Michelle Koltov, (301) 492-4225 for general information. Health Care Health Insurance Reporting and Recordkeeping Requirements Administrative Practice and Procedure Penalties Health Records Organization and Functions (Government Agencies) Claims Advertising Brokers Conflict of Interest Consumer Protection Grant Administration Grant Programs-Health Health Maintenance Organizations (Hmo) Hospitals Indians Individuals with Disabilities Intergovernmental Relations Loan Programs-Health Medicaid Public Assistance Programs Technical Assistance Women and Youth American Indian/Alaska Natives Cost-Sharing Reductions Grants Administration Health Maintenance Organization (Hmo) State and Local Governments Sunshine Act Women Youth Employee Benefit Plans Patient Protection and Affordable Care Act: Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program , HealthCare.gov http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsProjected.html http://www.HealthCare.gov/downloads/employer-coverage-tool.pdf http://www.hhs.gov/civil-rights/for-individuals/section-1557/1557faqs/index.html http://www.irs.gov/pub/irs-drop/rp-13-25.pdf http://www.naic.org/store/free/MDL-74.pdf http://www.rand.org/pubs/reports/R3055 http://www.urban.org/sites/default/files/alfresco/publication-pdfs/2000834-Helping-Special-Enrollment-Periods-Work-Under-the-Affordable-Care-Act.pdf http://www.usp.org/usp-healthcare-professionals/drug-classification https://marketplace.cms.gov/applications-and-forms/medicare-pdm-notice.pdf https://www.cbo.gov/sites/default/files/51298-2016-03-HealthInsurance.pdf https://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/Downloads/Appendix-A-to-June-30-2016-RA-and-RI-Report-5CR-063016.xlsx https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/RA-OnsiteQA-060816.pdf https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Downloads/uniform-mod-and-plan-wd-FAQ-06-15-2015.pdf https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/qa_hmr.html https://www.cms.gov/CCIIO/Resources/Files/Downloads/Av-csr-bulletin.pdf https://www.cms.gov/CCIIO/Resources/Files/Downloads/essential_health_benefits_bulletin.pdf https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Group-Instructions-4-4-clean-MM-508.pdf https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/Individual-Instructions-508-MM.pdf https://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/RA-March-31-White-Paper-032416.pdf https://www.cms.gov/cciio/resources/regulations-and-guidance/#Plan https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Appendix-A-Top-15.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Appendix-B-Sample-Translated-Taglines.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Cost-Sharing-Reduction-Reconciliation-Discrepancy-Resolution-Inbound-Specification.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/ENR_FFMSHOP_Manual_080916.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/final-state-avc-guidance.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-Updated-Federal-Standard-Renewal-and-Product-Discontinuation-Notices-090216.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Language-access-guidance.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/NA-Pilot-Final-Guidance-Clean-093016.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Updated-Guidance-on-Victims-of-Domestic-Abuse-and-Spousal-Abandonment_7.pdf https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index.html# https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index.html#Plan https://www.cms.gov/medicare/eligibility-and-enrollment/origmedicarepartabeligenrol/index.html https://www.cms.gov/mmrr/Downloads/MMRR2014_004_03_a03.pdf https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-10572.html?DLPage=1&DLEntries=10&DLFilter=CMS%20- https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsMethodology.pdf https://www.gpo.gov/fdsys/pkg/FR-2016-09-06/pdf/2016-20896.pdf https://www.nlm.nih.gov/research/umls/rxnorm/ https://www.regtap.info/faq_viewu.php?id=15449 https://www.regtap.info/faq_viewu.php?id=15450 https://www.regtap.info/uploads/library/ENR_FAQ_ResidencyPermanentMove_SEP_5CR_011916.pdf https://www.regtap.info/uploads/library/RA_Onsite_Discussion_Paper_Comments_5CR_080916.pdf https://www.whitehouse.gov/sites/default/files/omb/assets/legislative_reports/sequestration/jc_sequestration_report_2017_house.pdf www.irs.gov Vol. 81, no. 246 Office of the Federal Register, National Archives and Records Administration 2016-12-22 continuing daily deposited born digital 430 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2016-12-22 P0b002ee193187597 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr22de16 https://www.govinfo.gov/app/details/FR-2016-12-22 https://www.govinfo.gov/content/pkg/FR-2016-12-22/pdf/FR-2016-12-22.pdf https://www.govinfo.gov/content/pkg/FR-2016-12-22/xml/FR-2016-12-22.xml fdlp 93791 94210 DGPO 2016-12-21 2024-06-01 FR-2016-12-22 machine generated eng FR FR-2016-12-22 81 246