February 22nd, 2015
Each year the Centers for Medicare and Medicaid Services (CMS) releases a letter to issuers (insurers) in the federally facilitated marketplace (FFM) setting out the ground rules for coverage through the FFM for the coming year. A draft letter is published for comments, followed by the final letter. The letter addresses insurers that issue qualified health plans (QHPs) in the FFM, including stand-alone dental plans (SADPs), and covers the small business (FF-SHOP) marketplace as well as the individual marketplace.
On December 19, 2014, CMS published the draft 2016 letter which I covered here. On February 20, 2015, CMS published the final letter to issuers in the federally facilitated marketplace. Not surprisingly, since it covers the third year of operation of the marketplace, the 2016 letter is quite similar to those of preceding years. The letter is based on previously published rules governing QHPs and the marketplaces, as well as on the final 2016 Benefit and Payment Parameters Rule, covered here (CITE) and here (CITE), from which it incorporates many provisions.Read the rest of this entry »