The Cen­ters for Medicare & Med­ic­aid Ser­vices (CMS) released a pro­posed rule for ben­e­fit pay­ment and para­me­ters for 2020. CMS also released its draft 2020 actu­ar­i­al val­ue cal­cu­la­tor and draft 2020 actu­ar­i­al val­ue cal­cu­la­tor method­ol­o­gy.

Accord­ing to CMS, the pro­posed rule is intend­ed to reduce fis­cal and reg­u­la­to­ry bur­dens asso­ci­at­ed with the Patient Pro­tec­tion and Afford­able Care Act (ACA) across dif­fer­ent pro­gram areas and to pro­vide stake­hold­ers with greater flexibility.

Although the pro­posed rule would pri­mar­i­ly affect the indi­vid­ual mar­ket and the Exchanges, the pro­posed rule address­es the fol­low­ing top­ics that may impact employ­er-spon­sored group health plans:

  • Changes relat­ed to pre­scrip­tion drug policy
  • Small Busi­ness Health Options Pro­gram (SHOP)
  • Pro­hi­bi­tion against discrimination
  • Max­i­mum annu­al lim­i­ta­tion on cost shar­ing for plan year 2020
  • Cost-shar­ing require­ments for gener­ic drugs
  • Cost-shar­ing require­ments and drug man­u­fac­tur­ers’ coupons

CMS usu­al­ly final­izes its ben­e­fit pay­ment and para­me­ters rule in the first quar­ter of the year fol­low­ing the pro­posed rule’s release. Feb­ru­ary 19, 2019 is the due date for pub­lic com­ments on the pro­posed rule.

The 2020 open enroll­ment peri­od will run from Novem­ber 1, 2019, to Decem­ber 15, 2019.


by Karen Hsu
Orig­i­nal­ly post­ed on