PPACA; HHS Notice of Benefit and Payment Parameters for 2015

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The Department of Health and Human Services released a proposed rule change regarding payment parameters and oversight revisions of reinsurance, risk adjustment, cost sharing reductions, and user fees for the federally-facilitated marketplaces. In 2014, HHS will operationalize insurance premium stabilization programs (risk adjustment, reinsurance, and risk corridor) which are intended to mitigate the impact of adverse selection and stabilize the price of health insurance. This proposal will outline additional provisions that will help stabilize these programs.

The rule change includes a finalized risk adjustment methodology, updated payment parameters for 2015 reinsurance and uniform reinsurance contribution per capita of $44, and new calculations related to cost sharing. The user fee in 2015 for the use of the federally-facilitated marketplace is proposed at 3.5% of premium. The agency is seeking comment on proposed rule changes to some of their programs to address issues that could arise from transitional programs and people that are now able to continue receiving their current health insurance plan. To increase oversight, the agency is proposing they would be able to audit State-operated reinsurance programs.

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