Final HHS Notice of Benefit and Payment Parameters for 2017
Posted: March 4, 2016
Open enrollment concluded for the 2016 benefit year with 12.7 million people selecting/renewing a plan. Here at Innovative Insurance Group LLC, we closely monitor and review changes to regulations fundamental to our clients’ goals. The US Department of Health and Human Services (HHS) recently released the Final HHS Notice of Benefit and Payment Parameters for 2017. Here are some key changes:
Open Enrollment (Enrollment/Renewal)
For plan years 2019 and beyond, the open enrollment period to enroll/renew in a qualified health plan (QHP), will be shortened to 45 days, November 1 – December 15, 2018. For 2017 and 2018 plan years, open enrollment remains November 1 – January 31st
Adequacy (Continuity of Care)
While Centers for Medicare and Medicaid Services (CMS) language may be cumbersome and somewhat difficult to understand, it boils down to the following: If a provider will no longer be participating with an insurance carrier, (1) the carrier must notify patients that are seen on a regular basis or receive primary care from the provider in writing 30 days prior to the effective date of discontinuation or as soon as practical, and (2) If the provider contract is terminated “without cause”, the carrier is required to allow patients to continue active treatment with that provider until it is completed or for 90 days at in-network cost-sharing rates.
Network Adequacy (Cost sharing)
Effective 2018, in an effort to limit “surprise bills”, insurance carriers must count the enrollee cost sharing charges toward cost sharing annual limits for certain out-of-network services provided at an in-network facility by an “ancillary” provider, such as an anesthesiologist or radiologist. The requirement can be avoided by notifying the carrier that treatment may be received from an out-of-network provider at least 48 hours ahead or at the time of prior authorization. This does not apply when the difference between the network rate and charge is billed to the member.
In addition, the 2017 maximum annual limit for cost sharing has been set at $7,150 for individuals and $14,300 for family coverage (Increased from 2016 – $6,500 for individuals and $13,000)
Network Adequacy (Transparency)
While an adequacy standard or threshold was proposed but not finalized; to help consumers with plan selection, the Federally Facilitated Marketplace (Healthcare.gov) will include a rating for the network coverage of each qualified health plan (QHP) beginning 2017.
Here is the link to view the full notice: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-02-29.html