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  • Washington Highlights

    CMS Issues 2025 Notice of Benefit and Payment Parameters Final Rule

    Shahid Zaman, Director, Hospital Payment Policy
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) on April 2 issued the Notice of Benefit and Payment Parameters final rule for 2025, relating to issuers offering qualified health plans (QHPs) through federally facilitated Exchanges (FFEs) and state-based Exchanges on the federal platform (SBE-FPs). Exchanges are entities, established under the Patient Protection and Affordable Care Act (ACA, P.L. 111-148), through which qualified individuals and qualified employers can purchase health insurance coverage in QHPs.

    Highlights of the final rule include:

    • Allowing states to add routine adult dental services as an essential health benefit beginning Jan. 1, 2027.
    • Enhancing network adequacy standards for SBEs and SBE-FPs by requiring that beginning Jan. 1, 2026, QHPs have time and distance standards that are at least as stringent as standards for QHPs in FFEs.
    • Requiring issuers seeking certifications for their QHPs in SBEs or SBE-FPs to submit information about whether network providers offer telehealth services.
    • Extending special enrollment periods for individuals with household incomes at or below 150% of the federal poverty level to enroll in coverage in any month instead of only during the open enrollment period.

    The CMS also finalized proposals to streamline the enrollment process and standardize operations among FFEs and SBEs by requiring live call center representatives be available to assist with enrollment and automatically reenrolling individuals in a catastrophic plan to prevent lapses in coverage.