NYSDA Publications

CMS Issues Latest Regulatory Bulletin

The Centers for Medicare and Medicaid Services (CMS) has issued its regulatory bulletin, which can be read below.


HHS Releases Final Rule Impacting Marketplace Open Enrollment for Plan Year 2023

Today, the Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), announced new measures that will allow consumers to more easily find the right form of quality, affordable health care coverage on HealthCare.gov that best meets their needs.  These measures set the landscape for the upcoming HealthCare.gov Open Enrollment Period, which will begin on November 1, 2022, and are part of the Biden-Harris Administration's ongoing efforts to strengthen and build on the Affordable Care Act (ACA).  "The Affordable Care Act has successfully expanded coverage and provided hundreds of health plans for consumers to choose from," said Health and Human Services Secretary Xavier Becerra.  "By including new standardized plan options on HealthCare.gov, we are making it even easier for consumers to compare quality and value across health care plans.  The Biden-Harris Administration will continue to ensure coverage is more accessible to every American by building a more competitive, transparent, and affordable health care market."  "The recent Open Enrollment Period demonstrated the demand for high-quality, affordable health coverage.  These steps increase the value of health care coverage on HealthCare.Gov and further strengthen the health insurance Marketplace," said CMS Administrator Chiquita Brooks-LaSure.  "This policy will make it easier for people to choose the best plan that meets their needs by standardizing plan options, like maximum out-of-pocket limitations, deductibles, and cost-sharing features."  The 2023 Notice of Benefits and Payment Parameters Final Rule (final 2023 Payment Notice) makes regulatory changes in the individual and small group health insurance markets and establishes parameters and requirements issuers need to design plans and set rates for the 2023 plan year.  The rule also includes regulatory standards to help states, the Marketplaces, and health insurance companies in the individual and small group markets better serve consumers.  Major policies include:

• Advancing Standardized Plan Options
• Implementing New Network Adequacy Requirements
• Increased Value of Coverage for Consumers
• Increasing Access for Consumers and Removing Barriers to Coverage
• Expanding Access to Essential Community Providers
• Further Streamlining HealthCare.gov Operations

For more information, click the link below to view the full press release.

View the Full Press Release

To view the final rule in its entirety, go to: https://www.cms.gov/files/document/cms-9911-f-patient-protection-final-rule.pdf.  To view the final rule Fact Sheet, go to: https://www.cms.gov/newsroom/fact-sheets/hhs-notice-benefit-and-payment-parameters-2023-final-rule-fact-sheet.  To learn more about how standardized plans can support consumer decision-making and improve competition, please see the HHS Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief: https://aspe.hhs.gov/reports/standardized-plans-health-insurance-marketplaces.

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Your Most-Viewed Agent and Broker FAQs In April

Did you know the Agent and Broker Frequently Asked Questions (FAQs) website features more than 160 FAQs dedicated to providing answers to your top questions about assisting consumers with Marketplace coverage?  Each month, we'll highlight the top five FAQs that agents and brokers found to be the most helpful or most relevant to their needs.  Click the links below to find answers to the most-viewed FAQs in April.

1. What is Form 1095-A?

2. Which household income(s) should be included on a consumer's application? Should the total family income include income from family members that do not need the Federally-facilitated Marketplace (FFM) coverage?

3. How can I assist clients who have income that is difficult to predict, like those who are self-employed

4. My client does not file taxes jointly with their spouse. Are they eligible for financial assistance through the Marketplace?

5. What documents can be used to verify immigration status?

In addition to answering common questions, most FAQs include links to additional tools, calculators, or other resources to help you when assisting your clients.  Don't forget to bookmark the Agent and Broker FAQs website so you can easily refer to it when you need it.  Have additional questions?  Contact the Agent/Broker Email Help Desk at: FFMProducer-AssisterHelpDesk@cms.hhs.gov.

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Library Updates
Enrollment and Eligibility (ENR)
FFM Issuer Onboarding 2022 (4/29/22)

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