CMS Proposes Updates to ACA Exchange Plan Policies for 2021

Lexology February 17, 2020
Reed Smith LLP

The Centers for Medicare & Medicaid Services (CMS) has proposed updates to its standards for health plan issuers offering plans through federally-facilitated and state-based Exchanges for 2021. The proposed rule would, among other things: revise the risk adjustment methodology; update issuer user fees and cost-sharing limits; amend medical loss ratio regulations (including with regard to treatment of prescription drug rebates received and retained by an entity that provides pharmacy benefit management services to the issuer); modify special enrollment period rules; encourage value-based insurance plan designs; and make changes to the quality rating information display requirements for Exchanges.

With regard to drug manufacturer coupons, CMS proposes to give plans and issuers “flexibility to determine whether to include or exclude coupon amounts...

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