The 2020 Proposed Payment Notice, Part 1: Insurer And Exchange Provisions

On January 17, 2019, the Centers for Medicare and Medicaid Services (CMS) released its proposed 2020 Notice of Benefit and Payment Parameters rule. The proposed rule was accompanied by a fact sheet, the 2020 draft letter to insurers in the federal marketplace, key dates for calendar year 2019, a draft actuarial value (AV) calculator, and AV calculator methodology. CMS is accepting comments on the proposed rule through February 19, 2019.

Relative to the 2019 payment rule—which included sweeping changes in areas such as coverage of the essential health benefits package, navigator standards, and the SHOP exchanges—the proposed 2020 payment rule includes far fewer significant changes. Much of the entire 331-page rule is devoted to changes regarding direct enrollment...