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Department of Health and Human Services, Centers for Medicare & Medicaid Services: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024

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Highlights

GAO reviewed the Department of Health and Human Services, Centers for Medicare & Medicaid Services' (CMS), new rule entitled "Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024." GAO found that the final rule (1) includes payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation programs, as well as 2024 user fee rates for issuers offering qualified health plans (QHPs) through Federally-Facilitated Exchanges (FFEs) and State-Based Exchanges on the Federal Platform (SBE-FPs); and (2) has requirements related to updating standardized plan options and reducing plan choice overload; the automatic re-enrollment hierarchy; plan and plan variation marketing name requirements for QHPs; essential community providers and network adequacy; failure to file and reconcile; special enrollment periods; the annual household income verification; the deadline for QHP issuers to report enrollment and payment inaccuracies; requirements related to the State Exchange improper payment measurement program; and requirements for agents, brokers, and web-brokers assisting FFE and SBE-FP consumers.

Enclosed is our assessment of CMS's compliance with the procedural steps required by section 801(a)(1)(B)(i) through (iv) of title 5 with respect to the rule. If you have any questions about this report or wish to contact GAO officials responsible for the evaluation work relating to the subject matter of the rule, please contact Shari Brewster, Assistant General Counsel, at (202) 512-6398.

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