DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR ... - …

CMS-9926-P

This document is scheduled to be published in the Federal Register on 01/24/2019 and available online at , and on

[Billing Code: 4120-01-P]

DEPARTMENT OF HEALTH AND HUMAN SERVICES 45 CFR Parts 146, 147, 148, 153, 155, and 156 [CMS-9926-P] RIN 0938-AT37 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2020 AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS. ACTION: Proposed rule. SUMMARY: This proposed 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 (FFEs) and State-based Exchanges on the Federal Platform (SBE-FPs). It proposes changes that would allow greater flexibility related to the duties and training requirements for the Navigator program and proposes changes that would provide greater flexibility for direct enrollment entities, while strengthening program integrity oversight over those entities. It proposes policies that are intended to reduce the costs of prescription drugs. It includes proposed changes to Exchange standards related to eligibility and enrollment; exemptions; and other related topics. DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on February 19, 2019. ADDRESSES: In commenting, please refer to file code CMS-9926-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

Comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to . Follow the "Submit a comment" instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9926-P, P.O. Box 8016, Baltimore, MD 21244-8016.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY:

Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-9926-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850. For information on viewing public comments, see the beginning of the "SUPPLEMENTARY INFORMATION" section. FOR FURTHER INFORMATION CONTACT: Jeff Wu, (301) 492-4305, Ken Buerger, (410) 786-1190, or Abigail Walker, (410) 786-1725, for general information.

David Mlawsky, (410) 786-6851, for matters related to guaranteed renewability. Avareena Cropper, (410)-786-3794, for matters related to sequestration. Krutika Amin, (301) 492-5153, or Allison Yadsko, (410) 786-1740, for matters related to risk adjustment. Krutika Amin, (301) 492-5153, for matters related to Federally-facilitated Exchange and Statebased Exchange on the Federal Platform user fees. Abigail Walker, (410) 786-1725, Alper Ozinal, (301) 492-4178, Allison Yadsko, (410) 7861740, or Adam Shaw, (410) 786-1091, for matters related to risk adjustment data validation. Ken Buerger, (410) 786-1190, or LeAnn Brodhead, (410) 786-3943, for matters related to the opioid crisis. Amir Al-Kourainy, (301) 492-5210, for matters related to Navigators. Carly Rhyne, (301) 492-4188, for matters related to special enrollment periods. Amanda Brander, (202) 690-7892, for matters related to exemptions. Daniel Brown, (434) 995-5886, for matters related to direct enrollment. Rebecca Zimmermann, (301) 492-4396, for matters related to health insurance issuer drug policy, essential health benefits, and qualified health plan certification requirements. Amy Spiridon, (301) 492-4417, for matters related to the required contribution percentage, costsharing parameters and the premium adjustment percentage. SUPPLEMENTARY INFORMATION:

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Website as soon as possible after they

have been received: . Follow the search instructions on that Website to view public comments.

Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951. Table of Contents I. Executive Summary II. Background

A. Legislative and Regulatory Overview B. Stakeholder Consultation and Input C. Structure of Proposed Rule III. Provisions of the Proposed HHS Notice of Benefit and Payment Parameters for 2020 A. Part 146 ? Requirements for the Group Health Insurance Market B. Part 147 ? Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets C. Part 148 ? Requirements for the Individual Health Insurance Market D. Part 153 ? Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment under the Affordable Care Act E. Part 155 ? Exchange Establishment Standards and Other Related Standards under the Affordable Care Act

F. Part 156 ? Health Insurance Issuer Standards under the Affordable Care Act, Including Standards Related to Exchanges IV. Collection of Information Requirements A. Wage Estimates B. ICRs Regarding Guaranteed Renewability of Coverage C. ICRs Regarding Varying the Risk Adjustment Initial Validation Audit Sample Size D. ICRs Regarding Risk Adjustment Data Validation Exemptions E. ICRs Regarding Upload of Risk Adjustment Data F. ICRs Regarding Agent or Broker Termination and Web Broker Data Collection G. ICRs Regarding Direct Enrollment Entity Standardized Disclaimer H. ICRs Regarding Special Enrollment Periods I. ICRs Regarding Eligibility Standards for Exemptions J. Summary of Annual Burden Estimates for Proposed Requirements K. Submission of PRA-Related Comments V. Response to Comments VI. Regulatory Impact Analysis A. Statement of Need B. Overall Impact C. Impact Estimates of the Payment Notice Provisions and Accounting Table D. Regulatory Alternatives Considered E. Regulatory Flexibility Act F. Unfunded Mandates G. Federalism

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