Regulatory Analysis | Apr 6, 2015

Final HHS Notice of Benefit and Payment Parameters for 2016: Brief Summary of Key Provisions for the 2016 Plan Year

Georgetown University Health Policy Institute – Center on Health Insurance Reforms

On February 27, 2015, the federal Department of Health and Human Services published the Notice of Benefit and Payment Parameters for 2016 Final Rule, which included several provisions pertaining to form review.  This analysis, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, provides a brief summary of the key provisions specific to form review and other notable provisions specific to the 2016 plan year.  Included in the final rule are provisions on enrollment periods, definition of habilitative services, meaningful access to coverage materials, annual update to cost-sharing limits, pediatric age, and the drug exceptions process.


Expert Perspectives

September 6, 2024

Current Considerations for State Reinsurance Programs

Reinsurance is a long-standing tool for stabilizing health insurance markets and reducing premiums, and has played an important role in the success of the Affordable Care Act’s individual market as part of section 1332 state innovation waivers. Reinsurance increases affordability for consumers ineligible for the premium tax credit (PTC). However, the effects on PTC recipients are smaller, mixed, and have received little attention. This expert perspective summarizes recent research which raises questions about the impact of reinsurance programs on PTC recipients, and highlights related considerations for state policymakers.

CMS Issues Guidance on Renewal Timeliness Post-Unwinding

On August 29, 2024, the Centers for Medicare & Medicaid Services (CMS) released a CMCS Informational Bulletin (CIB) and accompanying slide deck to support states facing renewal backlogs. With this guidance, CMS is providing states additional time—until December 31, 2025—to complete Medicaid and CHIP eligibility renewals, address persistent backlogs in processing redeterminations, and achieve compliance with federal renewal timeliness requirements. This expert perspective provides an overview of the CIB.