Final 2023 Payment Rule, Part 1: Essential Health Benefits And Other Market Reforms

Health Affairs April 29, 2022
Katie Keith

On April 28, 2022, the U.S. Department of Health and Human Services (HHS) posted the final 2023 Notice of Benefit and Payment Parameters alongside a press release, a fact sheet, the final actuarial value calculator and methodology, the final letter to issuers, a final quality rating system information bulletin, and 2023 application materials for qualified health plans (QHPs).

The final rule touches on a range of topics, including a requirement that insurers offer standardized plans, new federal network adequacy standards, heightened standards for the inclusion of essential community providers in provider networks, a framework for discriminatory benefit design, clarification of medical loss ratio (MLR) calculations, user fees, risk adjustment, and more.

The final rule is quite similar to the proposed...