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《患者保护与平价医疗法案》;2017年美国卫生与公众服务部福利与支付参数通知。最终规则。

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2017. Final rule.

出版信息

Fed Regist. 2016 Mar 8;81(45):12203-352.

Abstract

This final rule sets forth payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; network adequacy; patient safety; the Small Business Health Options Program; stand-alone dental plans; third-party payments to qualified health plans; the definitions of large employer and small employer; fair health insurance premiums; student health insurance coverage; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions and appeals; and other related topics.

摘要

本最终规则规定了与风险调整、再保险和风险走廊计划相关的支付参数和条款;成本分摊参数和成本分摊削减;以及联邦政府设立的医保交易所的用户费用。它还提供了关于2017年和2018年受益年度个人市场年度开放注册期的额外修订;基本健康福利;成本分摊;合格健康计划;医保交易所消费者援助计划;网络充足性;患者安全;小企业健康选择计划;独立牙科计划;向合格健康计划的第三方支付;大雇主和小雇主的定义;公平健康保险保费;学生健康保险覆盖范围;费率审查计划;医疗损失率计划;资格与注册;豁免与申诉;以及其他相关主题。

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