ACA updating payment parameters for 2022

Sept. 21, 2021

In the Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond final rule, the Centers for Medicare & Medicaid Services (CMS) finalizes standards for issuers, Marketplaces and Navigators. This rule is a continuation of the recent rulemaking process, as seen in parts 1 and 2 of the Notice of Benefit and Payment Parameters for 2022 final rule, published on January 19 and May 5, 2021, respectively.

Overall, the rule expands access to health insurance coverage through the Marketplaces by lengthening the annual Open Enrollment Period, restoring and expanding Navigator duties, and minimizing burden and confusion for consumers. These changes further the Biden-Harris Administration’s goals of providing greater access to coverage, improving affordability for consumers, and reducing burden for issuers and consumers.

The Federally-facilitated Marketplace (FFM) Navigator Program reaches vulnerable and underserved populations. This program is important to increase awareness of coverage options available through the Marketplaces, help consumers find affordable coverage that meets their needs, and narrow health disparities.

Through this final rule, CMS reinstates the requirement that FFM Navigators provide consumers with information and assistance on certain post-enrollment topics, such as the Marketplace eligibility appeals process, the Marketplace-related components of the premium tax credit reconciliation process, and the basic concepts and rights of health coverage and how to use it. In addition, the rule expands the interpretation of what activities are encompassed in the duty to provide consumers with information and assistance related to the basic concepts and rights of health coverage and how to use it.

For the 2022 benefit year, we finalize an increase of the FFM user fee rate to 2.75% of premiums and the SBM-FP user fee rate to 2.25% of premiums. This is an increase from the rates previously finalized in part 1 of the 2022 Payment Notice – 2.25% and 1.75%, respectively. These rates account for funding for consumer information and outreach, including the FFM Navigator program. These rates are still lower than the current 2021 benefit year user fee rates.

The rule extends the annual individual market Open Enrollment Period for 2022 and future benefit years to allow consumers more time to review plan choices, seek in-person assistance, and enroll in a plan that best meets their needs. The annual Open Enrollment Period for all individual-market Marketplaces using the federal eligibility and enrollment platform and off-Marketplace individual market plans in states with such Marketplaces for 2022 and future benefit years will be November 1 of the prior year through January 15 of the benefit year. State Marketplaces not using the federal eligibility and enrollment platform maintain flexibilities regarding effective date rules and Open Enrollment end dates, provided the Marketplace’s Open Enrollment end date is no earlier than December 15 of the calendar year preceding the relevant benefit year.

To provide more opportunities for certain low-income consumers to access coverage with low or no premiums after APTC, such as under the American Rescue Plan (ARP), Marketplaces will now have the option to provide a monthly SEP for APTC-eligible consumers with a projected annual household income no greater than 150% of the FPL.

The rule will permit Marketplaces to provide a SEP for periods of time during which premium tax credits are available without the applicable taxpayer having to contribute toward their applicable portion of premiums before premium tax credits become available, such as those currently available under section 9661 of the ARP. Marketplaces on the federal platform will implement this SEP by providing eligible consumers with a pathway through the application during such periods of time.

CMS report