2021 Proposed Payment Notice Posted and Letter to Issuers Posted

On January 31, 2020, the Centers for Medicare & Medicaid Services (CMS) issued the proposed annual Notice of Benefit and Payment Parameters Rule for 2021, also known as the Proposed 2021 Payment Notice. This proposed rule would update regulatory and financial standards applied to issuers and Exchanges, as well as set parameters for the risk adjustment program. Similar to Payment Notices issued in prior years, the Proposed 2021 Payment Notice contains a number of other provisions that support the Trump Administration’s ongoing commitment to lowering premiums, protecting taxpayer dollars and strengthening the health insurance markets to deliver more competition and choice for consumers.

In conjunction with the proposed rule issued today, we are also issuing several guidance documents.  Links to those documents are below.

To view the proposed rule, click here:  https://www.federalregister.gov/public-inspection/current or the direct link at https://www.federalregister.gov/documents/2020/02/06/2020-02021/benefit-and-payment-parameters-notice-requirement-for-non-federal-governmental-plans

To view the proposed Key Dates for Calendar Year 2020 for QHP Certification, Rate Review, and Risk Adjustment, click here https://www.cms.gov/files/document/proposed-key-dates-tables-cy2020.pdf

To view the Draft ICD-10 Crosswalk for Potential Updates to HHS-HCC Risk Adjustment Model for the 2021 Benefit Year, click here https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/index.html#Premium-Stabilization-Programs

To view the proposed 2021 Letter to Issuers, click here: https://www.cms.gov/files/document/2021-draft-letter-issuers-clearance-version-final-13120.pdf

To view the request from Alabama to decrease the volume of transfers for Risk Adjustment, click here