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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules enrollment periods related to untimely notice of triggering events, cessation of employer contributions or government subsidies to COBRA continuation coverage, loss of APTC eligibility, and clarified the regulation imposing network adequacy standards with regard to QHPs that do not use provider networks.
4. Essential Health Benefits On December 16, 2011, HHS released a bulletin 14 that outlined an intended regulatory approach for defining EHB, including a benchmark-based framework. A proposed rule relating to EHBs was published in the November 26, 2012 Federal Register 77 FR
70643. We established requirements relating to EHBs in the Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation Final Rule, which was published in the February 25, 2013 Federal Register 78
FR 12833 EHB Rule. In the 2019
Payment Notice, published in the April 17, 2018 Federal Register 83 FR
16930, we added 156.111 to provide states with additional options from which to select an EHB-benchmark plan for plan years 2020 and beyond.
5. Section 1332 Waivers
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In the March 14, 2011 Federal Register 76 FR 13553, the Departments published the Application, Review, and Reporting Process for Waivers for State Innovation proposed rule 15 to implement section 1332a4B of the ACA. In the February 27, 2012 Federal Register 77 FR 11700, the Departments published the Application, Review, and Reporting Process for Waivers for State Innovation final rule 16
hereinafter referred to as the 2012
Final Rule. In the October 24, 2018
Federal Register 83 FR 53575, the Departments issued the 2018 Guidance, which superseded the previous guidance 17 published in the December 16, 2015 Federal Register 80 FR 78131
hereinafter referred to as the 2015
Guidance, and provided additional information about the requirements that states must meet for waiver proposals, the Secretaries application review procedures, pass-through funding determinations, certain analytical requirements, and operational 14 Essential Health Benefits Bulletin, December 16, 2011. Available at https www.cms.gov/CCIIO/
Resources/Files/Downloads/essential_health_
benefits_bulletin.pdf.
15 https www.govinfo.gov/content/pkg/FR-201103-14/pdf/2011-5583.pdf.
16 https www.govinfo.gov/content/pkg/FR-201202-27/pdf/2012-4395.pdf.
17 https www.govinfo.gov/content/pkg/FR-201512-16/pdf/2015-31563.pdf.

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considerations. In the November 6, 2020
Federal Register 85 FR 71142, the Departments issued an interim final rule 18 hereinafter referred to as the November 2020 IFC, which revises regulations to set forth flexibilities in the public notice requirements and post award public participation requirements for waivers under section 1332 during the COVID19 PHE. In the December 4, 2020 Federal Register 85 FR 78572, the Departments published the Patient Protection and Affordable Care Act;
HHS Notice of Benefit and Payment Parameters for 2022 and Pharmacy Benefit Manager Standards; Updates to State Innovation Waiver Section 1332
Waiver Implementing Regulations proposed rule 19 hereinafter referred to as the 2022 Payment Notice proposed rule to codify certain policies and interpretations of the 2018 Guidance. In the January 19, 2021 Federal Register 86 FR 6138, the Departments published the Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2022; Updates to State Innovation Waiver Section 1332 Waiver Implementing Regulations final rule 20
hereinafter referred to as the part 1 of the 2022 Payment Notice final rule which codified many of the policies and interpretations outlined in the 2018
Guidance into section 1332 regulations.
B. Stakeholder Consultation and Input HHS has consulted with stakeholders on policies related to the operation of Exchanges. We have held a number of listening sessions with consumers, providers, employers, health plans, advocacy groups and the actuarial community to gather public input. We have solicited input from state representatives on numerous topics, particularly the direct enrollment option for FFEs, SBEFPs and State Exchanges.
We consulted with stakeholders through monthly meetings with the National Association of Insurance Commissioners NAIC, regular contact with states, and health insurance issuers, trade groups, consumer advocates, employers, and other interested parties. We considered all public input we received as we 18 https www.federalregister.gov/documents/
2020/11/06/2020-24332/additional-policy-andregulatory-revisions-in-response-to-the-covid-19public-health-emergency.
19 https www.federalregister.gov/documents/
2020/12/04/2020-26534/patient-protection-andaffordable-care-act-hhs-notice-of-benefit-andpayment-parameters-for-2022-and.
20 https www.federalregister.gov/documents/
2021/01/19/2021-01175/patient-protection-andaffordable-care-act-hhs-notice-of-benefit-andpayment-parameters-for-2022.

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developed the policies in this proposed rule.
C. Structure of Proposed Rule The regulations outlined in this proposed rule would be codified in 45
CFR parts 147, 155, and 156. In addition, the regulations outlined in this proposed rule governing waivers under section 1332 of the ACA at 45 CFR part 155 subpart N would also be codified in 31 CFR part 33.
The proposed changes to part 147
would specify that issuers are not required to provide a special enrollment period in the individual market with respect to coverage offered outside of an Exchange to consumers who would be eligible for the proposed special enrollment period at 155.420d16.
The proposed changes to part 155
would repeal the establishment of the Exchange DE option, which permitted State Exchanges, SBEFPs, and FFEs to use direct enrollment technology and non-Exchange websites developed by approved web brokers, issuers and other direct enrollment partners to enroll qualified individuals in QHPs offered through the Exchange. We propose extending FFE open enrollment to end on January 15 of the applicable year, rather than December 15 of the previous year beginning with the 2022 coverage year and beyond. We also propose to reinstitute previous requirements that Navigators in FFEs be required to provide consumers with information and assistance on certain postenrollment topics, such as the Exchange eligibility appeals process, the Exchange-related components of the PTC reconciliation process, and the basic concepts and rights of health coverage and how to use it. We further propose to provide a monthly special enrollment period for qualified individuals or enrollees, or the dependents of a qualified individual or enrollee, who are eligible for APTC, and whose household income does not exceed 150 percent of the FPL. Finally, we propose to clarify that, for purposes of the special enrollment periods provided at 155.420d, a qualified individual or enrollee who qualifies for APTC, or a dependent whose tax filer can qualify for APTC on their behalf, because they meet the criteria at 155.305f, but who qualifies for a maximum APTC amount of zero dollars, is not considered APTC eligible for purposes of these special enrollment periods.
The proposed changes to part 156
would update the user fee rates for the 2022 benefit year for all issuers participating on the Exchanges using the Federal platform. We also propose to
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