CMS Issues Further Exchange Guidance: Second Final Notice of Benefit and Payment Parameters for 2022 and 2022 Final Letter to Issuers in the Federally-facilliated Exchanges

On April 30th, The Centers for Medicare and Medicaid Services (CMS) released the second final Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards (NBPP), as well as an accompanying fact sheet. Due to the change in administration in January, the Exchange guidance for the 2022 plan year was finalized in a piecemeal manner, with the following Qualified Health Plan and Exchange guidance finalized earlier this year:

  • CMS issued a first final NBPP on January 19th, 2021, addressing only a subset of the most significant policy proposals, including those related to Direct-only Enrollment and Section 1332 Waivers, as well as Exchange user fees.
  • In February, CMS finalized timelines for certification and rate filings of Qualified Health Plans that will be offered in Marketplaces in 2022.

The second final NBPP addresses many of the remaining proposals from the draft NBPP, including the much-anticipated final cost-sharing limitations for 2022 plans. The newly-issued final rule also addresses state reporting of mandated benefits related to Essential Health Benefits, as well as Medical Loss Ratio changes. Because proposals relative to Direct-only Enrollment, Section 1332 Waivers, and Exchange user fees were previously finalized, any additional changes—which, as noted below, are expected—will require a full rulemaking process.

On May 6, 2021, CMS followed the NBPP issuance with the release of the long awaited 2022 Final Letter to Issuers in the Federally-facilitated Exchanges (Letter). As in other recent years, the Letter contains few changes to existing guidance—though it does include changes relative to standalone dental plan maximum out-of-pocket limits and accreditation requirements.

The attached fact sheet from PCG Health Policy News outlines the key policy developments in the second final NBPP and the final Letter, with a focus on provisions that states must be mindful of when approaching the QHP certification process and key federal requirements.

Our next post on this topic will address areas of likely future rulemaking, as the Biden administration addresses provisions that were finalized under the Trump administration, as well as older provisions that were invalidated by a recent judicial ruling. Some of those provisions are directly flagged for future action in the preamble of the second final NBPP.

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