CMS: Benefit and Payment Parameters Final Rule, 6 Updates

1. CMS will establish a high-cost risk pool calculation in its risk adjustment methodology.
2. CMS will code several special enrollment periods to curb misuse and ensure regulation clarity.
3. CMS will address feedback that the current risk adjustment model underpredicts claims costs for individuals enrolled in health plans for only a portion of the year.
4. Prescription drug use data will be incorporated in risk adjustment models to better account for health risks of individuals with serious health issues.
5. CMS decided to maintain the user fee for federally-facilitated marketplaces at 3.5 percent of premiums for the 2018 benefit year.
6. A maximum annual limitation on cost sharing for 2018 of $7,350 for individuals and $14,700 for families was finalized.

Source: Becker's Hospital Review
Source URL: http://www.beckershospitalreview.com/payer-issues/12-things-...

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