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2019 Proposed Payment Notice

31-Oct-2017
Proposed 2019 Payment Notice (CMS-9930-P), Draft 2019 Actuarial Value Calculator,
Draft Sample Methodology for Comparing Benefits for a State’s EHB-benchmark Plan Selection and Shop Early Flexibility Guidance
 
TOPICS: 
Proposed 2019 Payment Notice: CMS is releasing the draft rule, “HHS Notice of Benefit and Payment Parameters for 2019” (the proposed 2019 Payment Notice), proposes payment parameters for the risk adjustment program; cost-sharing reductions; and user fees for the Federally-facilitated Exchanges and State-based Exchanges on the Federal platform.  Federal Register link: click here
 
Draft Actuarial Value Calculator: CMS is releasing the draft 2019 Actuarial Value (AV) Calculator.  CMS is updating the AV Calculator to keep it reflective of the current market and to ensure that the majority of plan designs can continue to use the AV Calculator.  
 
Draft Sample Methodology for Comparing Benefits for a State’s EHB-benchmark Plan Selection: CMS is releasing this draft guidance as a companion piece to the 2019 Payment Notice Proposed Rule. In that rule, CMS proposes new options from which States can select an essential health benefits (EHB) benchmark plan. If finalized as proposed, certain EHB-benchmark plan options would require the State to submit an actuarial certification and associated report on the State’s benchmark plan that affirms that the State’s EHB-benchmark plan is equal in scope to benefits provided under a typical employer plan.
 
Shop Early Flexibility Guidance: CMS is releasing guidance to provide early flexibility for issuers to begin adopting the proposed changes for SHOP starting at the beginning of PY 2018.