On September 17, 2021, the U.S. Departments of Health and Human Services and Treasury finalized the 2022 Notice of Benefit and Payment Parameters (NBPP) rule and announced a significant expansion of their oversight of health plans’ provider networks. This expert perspective reviews provisions of the rule of particular import to the state-based marketplaces (SBMs) and state insurance regulators.
Qualified Health Plan Review in Marketplaces with State Plan Management: An Analysis of the Division of Labor Between State Exchanges and Other State Agencies
Gabbie Nirenburg, JD, MS, and Arthur Thourson Jones, PhD, Leonard Davis Institute of Health Economics
States have implemented a variety of different methods to handle the review and certification of qualified health plans (QHPs). The Health Insurance Exchanges (HIX) Research Group at the Leonard Davis Institute of Health Economics at Wharton (LDI) recently collected data from 30 states, including those with State Based Marketplaces (SBMs), State Partnership Marketplaces (SPMs), Supported State Based Marketplaces (SSBMs), and Federally Facilitated Marketplaces (FFMs) with state plan management. This brief summarizes the findings within this dataset, which outlines the various plan management and certification functions assumed by different state agencies across these marketplace models.
The full dataset and codebook is available here. The dataset also highlights the role CMS plays in SPM, SSBM, and FFM with state plan management states.