NHC Comments on Proposed 2022 Notice of Benefit and Payment Parameters


By Madison Mason, Senior Associate, Policy 

On December 30, 2020the National Health Council (NHC) submitted comments to the Centers for Medicare and Medicaid Services (CMS) on their proposed Notice of Benefit and Payment Parameters (NBPP) for 2022 under the Patient Protection & Affordable Care Act (PPACA)The NHC recognizes that the long-term viability of the PPACA is dependent on the stability of the individual health plan marketplaces and meaningful outreach, engagement, and communication throughout the enrollment processes.  

The NHC is committed to ensuring that those with chronic diseases and disabilities have access to affordable, high-value, sustainable health care. We will continue to support policies that enhance market stability if they align with our mission. The COVID-19 pandemic has served as an important reminder and emphasized how critical it is to ensure that all people have access to adequate and affordable health insurance coverage. We believe, now more than ever, that coverage under the PPACA must be: 

    • Adequate: Health care coverage should cover treatments patients need, including the services in the essential health benefit package; 
    • Affordable: It should enable patients to access the treatments they need to live healthy and productive lives; and 
    • Accessible: Coverage and enrollment should be easy to understand, not pose a barrier to care, and benefits should be clearly defined.  

The NHC urges CMS to finalize policies related to the 2022 PPACA plan year that take into account the financial, physical, and mental health of the American people by making sure that health coverage is adequate, equitable, affordable, and accessible. We oppose provisions that would increase costs or reduce access to coverage and/or care. NHC specifically responded to the proposed rule by stating that we: 

    • Support CMS’ proposed amendments to the special enrollment period (SEP) policy and offer recommendations to strengthen enrollee access to coverage that best suits their needs, including: 
        • Improving newly advance premium tax credits (APTC) – ineligibility to allow patient choice in plan selection; and  
        • Strengthening the Consolidated Omnibus Budget Reconciliation Act (COBRA) discontinuation SEP policy; 
    • Urge a SEP – eligibility-determination approach that reflects and responds to determination errors over a pre-set 75 percent standard; 
    • Oppose CMS’ proposal to reduce marketplace user fees; 
    • Oppose changes to the Premium Adjustment Percentage Index (PAPI) and Maximum Annual Limitation on Cost-Sharing, also known as maximum out-of-pocket (MOOP), that would result in financial burdens for patients; 
    • Support CMS’ proposals to ensure calculations of medical loss ratio (MLR) exclude drug rebates and price concessions, and to facilitate transparency through pharmacy benefit manager (PBM) reporting requirements;  
    • Oppose CMS’ proposal to permit states to implement Direct Enrollment mechanisms without submitting an application for a section 1332 waiver; 
    • Oppose CMS’ proposed codification of the 2018 guidance interpreting Section 1332 guardrails; and 
    • Urge CMS to return to its earlier position on Copay Accumulators and Maximizers to distinguish between products with and without generic competition. 

For more details on the NHC’s response to the Proposed Rule, please check-out our letter