Implementing Health Reform: 2016 Benefit And Payment Parameters Proposed Rule, Consumer Provisions; Hardship Exemptions

Abstract

On November 15, 2014, the marketplaces reopened for 2015. Anecdotal reports indicate that in most places enrollment and reenrollment are running smoothly. But the Centers of Medicare and Medicaid Services (CMS) of the Department of Health and Human Services (HHS) is looking forward to 2016. On November 21 CMS published its massive 2016 Notice of Benefit and Payment Parameters (BPP) Proposed Rule with accompanying fact sheet. It also published the draft 2016 actuarial value calculator and draft actuarial value calculator methodology for 2016. Finally, CMS published a guidance on hardship exemptions for certain individuals. Not to be outdone, the Department of the Treasury, Internal Revenue Service released its final regulation on Minimum Essential Coverage and other Rules Regarding the Shared Responsibility Payment for Individuals, together with a Notice regarding Individual Shared Responsibility Payment Hardship Exemptions that May be Claimed on a Federal Income Tax Return Without Obtaining a Hardship Exemption Certificate from the Marketplace and a Revenue Procedure setting out indexed adjusted percentages of income that will be used for determining the level of contributions expected of individuals before premium tax credits become available, the affordability threshold for the shared responsibility payments unaffordability exemption, and the threshold for determining whether employer coverage is affordable for purposes of determining eligibility for tax credits. Finally, the Office of Personnel Management released a lengthy proposed rule proposing modifications in the multi-state plan program. These rules, proposed rules, and guidances will be addressed in a series of posts over the next several days. This post will address primarily the consumer-facing provisions of the BPP proposed rule, focusing on changes in benefits. A second post will follow, discussing the provisions of the rule more relevant to insurers, such as proposed changes in the reinsurance, risk adjustment, and risk corridor rules. A final post will discuss the IRS rule, which is primarily a finalization of proposals and guidances already made public, and the OPM multi-state plan rule.