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  • Washington Highlights

    CMS Finalizes 2026 Notice of Benefit and Payment Parameters Rule

    Shahid Zaman, Director, Hospital Payment Policy
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) issued the Notice of Benefit and Payment Parameters final rule for 2026, relating to issuers offering qualified health plans (QHPs) through federally facilitated Marketplaces and state-based Exchanges on the federal platform (SBE-FPs). Exchanges are entities, established under the Patient Protection and Affordable Care Act (P.L. 111-148, PDF), through which qualified individuals and qualified employers can purchase health insurance coverage in QHPs.

    Highlights of the final rule include strengthening review and enforcement of unscrupulous broker and agent practices; refining the risk adjustment program to phase out a market pricing adjustment for hepatitis C drugs and to include an HIV pre-exposure prophylaxis affiliated cost factor; increasing user fees in anticipation of the expiration of enhanced premium subsidies under the Inflation Reduction Act of 2022 (P.L. 117-169); and improving transparency and public reporting of data on SBEs and SBE-FPs.

    The provisions of the final rule went into effect Jan. 15 and apply to plan year 2026.