The Centers for Medicare & Medicaid Services (CMS) on May 15 released the Notice of Benefit and Payment Parameters 2027 final rule (PDF). This final rule contains policies aimed at issuers offering qualified health plans (QHPs) through federally facilitated exchanges (FFE) and state-based exchanges on the federal platform. Exchanges are entities, established under the Patient Protection and Affordable Care Act (P.L. 111-148, PDF), through which qualified individuals and employers can purchase health insurance coverage in QHPs. The AAMC previously shared comments in response to the proposed rule [refer to Washington Highlights, March 13].
The rule finalized several proposals related to eligibility, enrollment, and benefit design, including:
- Allowing nonnetwork plans to serve as a QHP through the FFE beginning in plan year (PY) 2028, a one-year delay from the original proposal.
- Increasing eligibility for noncomprehensive, high-cost catastrophic plans.
- Allowing for multiple consecutive plan years (up to 10) and changes to the permissible cost-sharing parameters for catastrophic plans and individual market bronze plans.
- Removing time and distance standards from network adequacy standard requirements for state exchanges and state-based exchanges on the federal platform that are at least equal to QHPs participating in the FFEs.
The CMS did not finalize its proposal to reduce the standard for demonstrating a sufficient number and geographic distribution of Essential Community Providers (ECPs). The proposal would have reduced the minimum percentage of ECPs that must be contracted within each plan’s service area from 35% to 20%. The AAMC supports the higher minimum percentage and asked the CMS not to finalize this proposal in its comments on the proposed rule.