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CMS releases final notice of benefit, payment parameters for 2020

May 16, 2019 Baltimore — The Centers for Medicare and Medicaid Services has released its final Notice of Benefit and Payment Parameters for 2020.

The final notice approved the provisions from the proposed rule, including one authorizing navigators to provide consumers assistance with topics not specifically mentioned in the Affordable Care Act and to loosen the navigators’ training standards. Navigator programs were established under the ACA to help consumers understand available coverage options.

In joint comments filed Feb. 19, the ADA and American Academy of Pediatric Dentistry said they opposed this provision, in part, because they believe the navigators need more training to educate and inform consumers about dental plans.

In the 2019 NBPP, CMS finalized options for states to select new Essential Health Benefit-benchmark plans. The third of these options would allow states to select a set of benefits for the EHB-benchmark plan. The ADA and AAPD said they were concerned that this will give states the opportunity to weaken the EHBs, including the oral health benefit for children. The 2020 NBPP sets an earlier deadline for states to submit their EHB-benchmark plan selection, which the ADA and AAPD believe does not give states enough time to evaluate the impact of their choice on vulnerable populations.

The 2020 rule also changes the way that premium assistance is calculated by basing the premium adjustment percentage on private individual and group market health insurance premiums. The ADA and AAPD think that this change will increase premiums for exchange plans and decrease enrollment for consumers who receive the premium tax credit. The change in calculating the premium adjustment percentage will also increase the limit on cost-sharing, which will further decrease the affordability of exchange plans.

Also on April 18, CMS issued its 2020 letter to issuers which states that CMS’ approaches to network adequacy, essential community providers and the actuarial value for stand-alone dental plans remains unchanged from 2019.

The NBPP is issued by CMS on an annual basis to implement changes to Affordable Care Act requirements and programs. For more information, visit CMS.gov and search “benefit and payment parameters.”