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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
Payment Notice final rule,70 we indicated the intention to propose to increase the user fee rates for the 2022
benefit year in future rulemaking.
Therefore, in this rule, HHS proposes new QHP issuer user fee rates for the 2022 plan year: A new FFE user fee rate of 2.75 percent of total monthly premiums, and a new SBEFP user fee rate of 2.25 percent of monthly premiums. These proposed rates are based on internal projections of federal costs for providing special benefits to FFE and SBEFP issuers during the 2022 benefit year, taking into account estimated changes in parameters, specifically the increased funding to the FFE Navigator program and consumer outreach and education. HHS is of the view that pursuit of this proposal is necessary for consistency with E.O.
14009 and this Administrations goal of protecting and strengthening the ACA
and making high-quality health care accessible and affordable for every American. We believe that expanded outreach and education will lead to broader risk pools, lower premiums, fewer uninsured consumers, and expanded use of Exchange services.
Section 1311d5A of the ACA
permits an Exchange to charge assessments or user fees on participating health insurance issuers as a means of generating funding to support its operations. If a state does not elect to operate an Exchange or does not have an approved Exchange, section 1321c1
of the ACA directs HHS to operate an Exchange within the state. Accordingly, in 156.50c, we specify that a participating issuer offering a plan through an FFE or SBEFP must remit a user fee to HHS each month that is equal to the product of the annual user fee rate specified in the annual HHS
notice of benefit and payment parameters for FFEs and SBEFPs for the applicable benefit year and the monthly premium charged by the issuer for each policy where enrollment is through an FFE or SBEFP. In addition, OMB Circular No. A25 establishes federal policy regarding the assessment of user fee charges under other statutes, and applies to the extent permitted by law. Furthermore, OMB Circular No. A
25 specifically provides that a user fee charge will be assessed against each identifiable recipient of special benefits derived from federal activities beyond those received by the general public.
Activities performed by the federal government that do not provide issuers participating in an FFE with a special benefit, or that are performed by the federal government for all QHPs,
including those offered through State Exchanges, are not covered by this user fee. As in benefit years 2014 through 2021, issuers seeking to participate in an FFE in the 2022 benefit year will receive two special benefits not available to the general public: 1 The certification of their plans as QHPs; and 2 the ability to sell health insurance coverage through an FFE to individuals determined eligible for enrollment in a QHP.
a. FFE User Fee Rate For the 2022 benefit year, issuers participating in an FFE will receive the benefits of the following federal activities:
Under Consumer Information and Outreach:
Provision of consumer assistance tools;
Consumer outreach and education;
and Management of a Navigator program.
Under Health Plan Bid Review, Management, and Oversight:
Certification processes for QHPs including ongoing compliance verification, recertification, and decertification; and Regulation of agents and brokers.
Under Eligibility and Enrollment:
Eligibility determinations; and Enrollment processes.
Activities through which FFE issuers receive a special benefit also include use of the Health Insurance and Oversight System HIOS, which is partially funded by FFE and SBEFP
user fees, and the Multidimensional Insurance Data Analytics System MIDAS platform, which is fully funded by FFE and SBEFP user fees. In light of E.O. 14009,71 published on January 28, 2021, the administration has a priority to increase accessibility and affordability of health care for every American. Consistent with increasing accessibility for every American an expanded budget for consumer support activities and Navigators was developed, and HHS conducted additional analytic review which revealed that the user fee rates established in part 1 of the 2022
Payment Notice final rule 72 need to be increased to sustain essential Exchangerelated activities. Based on this new analysis of the increased contract costs and projected premiums and enrollment including changes in FFE enrollment resulting from anticipated establishment of State Exchanges or SBEFPs in 71 86

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certain states in which FFEs currently are operating for the 2022 plan year, we are proposing to establish the FFE user fee for all participating FFE issuers at 2.75 percent of total monthly premiums.
We seek comment on this proposed FFE user fee rate for 2022.
b. SBEFP User Fee Rate As previously discussed, OMB
Circular No. A25 establishes federal policy regarding user fees, and specifies that a user charge will be assessed against each identifiable recipient for special benefits derived from federal activities beyond those received by the general public.
SBEFPs enter into a Federal platform agreement with HHS to leverage the systems established for the FFEs to perform certain Exchange functions, and to enhance efficiency and coordination between state and federal programs.
Accordingly, in 156.50c2, we specify that an issuer offering a plan through an SBEFP must remit a user fee to HHS, in the timeframe and manner established by HHS, equal to the product of the monthly user fee rate specified in the annual HHS notice of benefit and payment parameters for the applicable benefit year and the monthly premium charged by the issuer for each policy where enrollment is through an SBEFP, unless the SBEFP and HHS
agree on an alternative mechanism to collect the funds from the SBEFP or state.
The benefits provided to issuers in SBEFPs by the federal government include use of the federal Exchange information technology and call center infrastructure used in connection with eligibility determinations for enrollment in QHPs and other applicable state health subsidy programs, as defined at section 1413e of the ACA, and QHP
enrollment functions under 155.400.
The user fee rate for SBEFPs is calculated based on the proportion of FFE costs that are associated with the FFE information technology infrastructure, the consumer call center infrastructure, and eligibility and enrollment services, and allocating a share of those costs to issuers in the relevant SBEFPs, as issuers in SBEFPs receive those special benefits and will be able to access the increased consumer support and education.
Similar to the FFE, activities through which SBEFP issuers receive a special benefit also include use of HIOS, which is partially funded by FFE and SBEFP
user fees, and the MIDAS platform, which is fully funded by FFE and SBE
FP user fees. In light of E.O. 14009,73 the 73 86

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