“GAO reviewed the Department of Department of Health and Human Services’ (HHS) new rule entitled “Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023.” GAO found that the final rule (1) includes payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs, as well as 2023 user fee rates for issuers offering qualified health plans (QHPs) through federally-funded Exchanges and state-based Exchanges on the federal platform; (2) includes requirements related to guaranteed availability; the offering of QHP standardized plan options through Exchanges on the federal platform; requirements for agents, brokers, and web-brokers; verification standards related to employer sponsored coverage; Exchange eligibility determinations during a benefit year; special enrollment period verification; cost-sharing requirements; Essential Health Benefits; Actuarial Value; QHP issuer quality improvement strategies; accounting for quality improvement activity expenses and provider incentives for medical loss ratio reporting and rebate calculation purposes; and re-enrollment; and (3) responds to comments on how HHS can advance health equity through QHP certification standards and otherwise in the individual and group health insurance markets, and how HHS might address plan choice overload in the Exchanges.”
“Enclosed is our assessment of HHS’s compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule…”
Access the full 5-page report here.
Source: Department of Health and Human Services: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023 – May 12, 2022. GAO.
