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This annual proposed rule would set forth payment parameters and provisions related to the risk adjustment programs; cost-sharing parameters; and user fees for issuers offering plans on Federally-facilitated Exchanges and State-based Exchanges using the Federal platform.  It would also provide additional standards for several other Affordable Care Act programs.

Statement of Need:

This rule will propose standards related to the risk adjustment program for the 2020 benefit year, as well as certain modifications that will promote state flexibility and control over their insurance markets, reduce burden on stakeholders, and improve program integrity.

Summary of the Legal Basis:

This rule addresses multiple sections of the Patient Protection and Affordable Care Act (Pub. L. 111148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111152), which amended and revised several provisions of the Patient Protection and Affordable Care Act.

Alternatives:

We considered slight variants of the proposed policies related to the risk adjustment program and standards related to the Exchanges.

Anticipated Costs and Benefits:

We anticipate that the proposed changes will include some initial costs on stakeholders, but generate savings over the long term.  As we move toward publication, estimates of the cost and benefits of these provisions will be included in the rule.

Risks:

If this regulation is not published timely, issuers in the individual and small group market will not have important information for rate setting for the 2020 plan year, and changes applicable to qualified health plans will not be in place in time for the 2020 plan year .