Avalere Health
An Inovalon Company
Insights

Dec 03, 2013

Notice of Benefit and Payment Parameters 2015 Proposed Rule

Published

Dec 03, 2013

On Nov. 25, HHS released the Proposed Notice of Benefit and Payment Parameters for 2015 that provides technical details and policy parameters related to the advance payments of the premium tax credits (APTC), cost-sharing reductions (CSRs) and premium stabilization programs.

The Notice also provides information regarding exchange operations for the 2015 plan year and possible changes to the risk mitigation programs for 2014 in light of the recently announced policy change under which HHS has established a transitional policy for grandfathering plans.

The Proposed Notice includes a number of proposed changes to the 2014 risk mitigation programs — specifically the reinsurance and risk corridor programs — to help alleviate plan concerns over the recently announced transitional policies for grandfathered plans. Overall, HHS did not make meaningful changes to the risk mitigation programs for 2015. HHS did however announce a number of changes that could potentially impact consumers in 2015 and that could lead to consumer confusion. The open enrollment period for 2015 will begin on Nov. 15 and end Jan. 15, potentially leading to gaps in coverage if 2014 policies are not extended into 2015.  

This Proposed Notice codifies a number of announcements that the Administration has made as they continue to struggle with technological issues that are plaguing healthcare.gov. Avalere anticipates that stakeholders will have significant comments on the proposals to changes for the risk mitigation programs for 2014 and exchange operations for 2015.  Comments are due on Dec. 26, 2013, 30 days after the date of filing for public inspection.

The Proposed Notice is available here.

Select highlights from the Proposed Notice are below:

  • Risk Mitigation Programs: To mitigate unexpected losses for issuers as a result of the recently announced transitional policy, HHS is considering calculating a state-specific percentage adjustment to risk corridors as well as an alternative option to make adjustments to the medical loss ratio (MLR) formula. HHS is also proposing to lower the 2014 attachment point for the reinsurance program from $60,000 to $45,000. Finally, HHS proposes to exclude self-insured, self-administered plans from the reinsurance contributions for 2015 and 2016.
  • Patient Cost-Sharing: HHS proposes to set the maximum out-of-pocket (MOOP) amount for 2015 at $6,750 for self only coverage and $13,500 for family coverage. The maximum deductible in the small group market will be set at $2,150 for self only coverage and $4,300 for family coverage. HHS is not proposing to change the MOOP amounts for silver plan variations.
  • Meaningful Difference Standard: HHS proposes to impose a meaningful difference standard on QHPs for 2015. To be considered meaningfully different, HHS proposes that for a plan within a given service area and metal tier, a “reasonable consumer” must be able to identify at least two material differences between the plan and other plans offered by the same issuer.
Back to Results
« Back to Mobile Site