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 2018_register executive 2019-03-20 article Part II Rules and Regulations D09002ee1c7e8a832 D09002ee1c7e8aae8 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 and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally- facilitated Exchanges and State Exchanges on the Federal platform. It finalizes changes that provide additional flexibility to States to apply the definition of essential health benefits (EHB) to their markets, enhance the role of States regarding the certification of qualified health plans (QHPs); and provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics. 83 FR 16930 https://www.govinfo.gov/app/details/FR-2018-04-17/2018-07355 2018-07355 fr17ap18-15 RIN 0938-AT12 4120-01-P CMS-9930-F https://www.govinfo.gov/app/details/FR-2018-04-17/2018-07355 https://www.govinfo.gov/content/pkg/FR-2018-04-17/html/2018-07355.htm https://www.govinfo.gov/content/pkg/FR-2018-04-17/pdf/2018-07355.pdf Health Care Health Insurance Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Records Intergovernmental Relations Organization and Functions (Government Agencies) Claims Penalties Advertising Brokers Conflict of Interests Consumer Protection Grants Administration Grant Programs-Health Health Maintenance Organizations (Hmo) Hospitals Indians Individuals with Disabilities Loan Programs-Health Medicaid Public Assistance Programs Technical Assistance Women and Youth Advisory Committees Health Maintenance Organization (Hmo) State and Local Governments Sunshine Act Women Youth Employee Benefit Plans 142 p. 16930 17071 83 FR 16930 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 157 45 CFR Part 157 Title 45 Part 158 45 CFR Part 158 RIN 0938-AT12 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2019; Federal Register Vol. 83, Issue RULE 2018-07355 II DEPARTMENT OF HEALTH AND HUMAN SERVICES 2018-06-18 CMS-9930-F 4120-01-P 2018-07355 Final rule.

This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally- facilitated Exchanges and State Exchanges on the Federal platform. It finalizes changes that provide additional flexibility to States to apply the definition of essential health benefits (EHB) to their markets, enhance the role of States regarding the certification of qualified health plans (QHPs); and provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics.

Effective Date: These regulations are effective on June 18, 2018. Lindsey Murtagh, (301) 492-4106, Rachel Arguello, (301) 492-4263, Alper Ozinal, (301) 492-4178, or Abigail Walker, (410) 786-1725, for general information. Health Care Health Insurance Reporting and Recordkeeping Requirements Administrative Practice and Procedure Health Records Intergovernmental Relations Organization and Functions (Government Agencies) Claims Penalties Advertising Brokers Conflict of Interests Consumer Protection Grants Administration Grant Programs-Health Health Maintenance Organizations (Hmo) Hospitals Indians Individuals with Disabilities Loan Programs-Health Medicaid Public Assistance Programs Technical Assistance Women and Youth Advisory Committees 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 2019 , RARIpaymentoperations@cms.hhs.gov HealthCare.gov http://health.oliverwyman.com/transform-care/2017/11/risk_adjustment.html http://www.ballotpedia.org http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/mec-guidance-10-31-2013.pdf 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Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2018-04-17 P0b002ee19ffebd6d 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr17ap18 https://www.govinfo.gov/app/details/FR-2018-04-17 https://www.govinfo.gov/content/pkg/FR-2018-04-17/pdf/FR-2018-04-17.pdf https://www.govinfo.gov/content/pkg/FR-2018-04-17/xml/FR-2018-04-17.xml fdlp 16767 17076 DGPO 2019-03-20 2024-06-01 FR-2018-04-17 machine generated eng FR FR-2018-04-17 83 74