HHS follows up on Draft Notice of Benefit and Payment Parameters with the Releases of the Draft Letter to Issuers

The release of key Health Benefit Exchange guidance was staggered this year; in follow-up to the release of the Draft Notice of Benefit and Payment Parameters in earlier in the month, the Department of Health and Human Services (HHS) released its Draft 2027 Letter to Issuers in the Federally-facilitated Exchanges (Letter) at the end of February. As is typical, the Letter addresses a broad range of topics related to Qualified Health Plan (QHP) standards and the certification process, as well as rules for consumer support and information and QHP oversight. 
Below we explore key proposed policy changes outlined in the Letter – those that expand on changes proposed in the NBPP (which we outlined in greater detail last month) as well as additional proposals. For more information on these topics and others we encourage you to consult the full Letter. The comment period on the draft Letter closed on March 23rd. 

Standardized Plans

The Letter reiterates the proposal from the NBPP to effectively discontinue standardized plans, noting that issuers can continue to offer such plans, but they will no longer be required nor receive differential display, and CMS will no longer issue standardized plan designs. The Letter notes that if an issuer modifies the cost sharing for a current standardized plan, the plan would likely – but not necessarily – be considered a new plan, depending on state rules. Additionally, like the NBPP, the Letter proposes to eliminate limitations on non-standardized plan offerings. While issuers would no longer be required to seek an exception to offer more than two non-standardized plans per product network type, service area, and other enumerated factors in order to offer a chronic and high-cost condition plan, they could also choose to continue offering these plans. Any changes to those plans would also likely create a new plan. 

Network Adequacy and Essential Community Provider Standards

The Letter also addresses another policy area to which the NBPP proposed significant change. The Letter reiterates the proposal to allow FFE states more latitude in conducting provider network adequacy reviews and to allow non-network plans – which will be certified based on attestation – though notes that CMS will continue to collect provider data via the Network Adequacy Template in order to support states and for measuring compliance with appointment wait time standards and in states not conducting their own adequacy reviews. The federal time and distance standards to be used in states not conducting their own reviews remain unchanged, as does the approach to appointment wait times. 

The Letter also reiterates updates to Essential Community Provider (ECP) standards from the NBPP, allowing states to do the certification review and non-network plans to satisfy ECP standards. The letter also notes the reduced minimum threshold required of 20% and that the changes to the justification standards will not change the submission requirements. Similar to network adequacy, CMS notes that it will continue to collect ECP data in all FFE states. 

Prior Authorization

The Letter addresses a key topic outside of the NBPP this year – reporting requirements relative to the 2024 CMS Interoperability and Prior Authorization Rule. Data reporting relative to prior authorization will begin this year and, in an effort to streamline the process, the Letter requires that the data be submitted through the QHP certification process. 

Also starting this year, issuers are required to provide specific reasons for prior authorization denials in their responses.