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《患者保护与平价医疗法案》;美国卫生与公众服务部2018年保险福利与支付参数通知;特殊注册期及消费者运营与导向型计划项目的修订。最终规则。

Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2018; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program. Final rule.

出版信息

Fed Regist. 2016 Dec 22;81(246):94058-183.

Abstract

This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics.

摘要

本最终规则规定了与风险调整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和联邦平台上基于州的医保交易所的用户费用。它还提供了有关标准化选项、合格健康计划、消费者援助工具、网络充足性、小企业健康选项计划、独立牙科计划、公平健康保险保费、保证承保和保证续保、医疗损失率计划、资格与参保、申诉、消费者运营和导向型计划、特殊参保期以及其他相关主题的补充指导意见。

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