News & Perspectives

CMS releases more Marketplace guidance

8. December 2017 Lisa Kaplan Howe Health

Weeks after releasing proposed Marketplace regulations, the Centers for Medicare & Medicaid Services (CMS) released its annual Draft Letter to Issuers in the Federally-facilitated Exchanges (Letter) for the 2019 plan year on November 27th. As is typical, the draft Letter provides operational and technical guidance relative to Qualified Health Plan (QHP) certification to issuers seeking to offer QHPs and Standalone Dental Plans on Federally-Facilitated Exchanges (FFEs) and State-Based Exchanges on the Federal Platform (SBE-FPs). At the same time, CMS also released guidance on the rate review timeline and other key dates for certification of QHPs for the 2019 plan year.

This year’s letter largely refers readers to policies outlined in the 2018 Letter. CMS also reiterated many of the changes proposed in the Proposed Notice of Benefit and Payment Parameters (NBPP) for 2019, including related to state responsibilities for reviewing plan compliance with certification criteria, eliminating standardized plans, and changes to the Small Business Health Options Program (SHOP) and standalone dental plans. Comments on the Letter are due on December 11, 2017.

Members of the Health Innovation Policy Information Technology team updated PCG’s summary of the NBPP to reflect the Letter. Please email Lisa Kaplan Howe at for the summary.