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Federal Register / Vol. 86, No. 124 / Thursday, July 1, 2021 / Proposed Rules
DEPARTMENT OF THE TREASURY
31 CFR Part 33
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Centers for Medicare & Medicaid Services 45 CFR Parts 147, 155 and 156
CMS9906P
RIN 0938AU60

Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule Centers for Medicare &
Medicaid Services CMS, HHS.
Department of the Treasury.
ACTION: Proposed rule.
AGENCY:

This proposed rule sets forth proposed revised 2022 user fee rates for issuers offering qualified health plans QHPs through Federally-facilitated Exchanges FFEs and State-based Exchanges on the Federal platform SBEFPs; proposes repeal of separate billing requirements related to the collection of separate payments for the portion of QHP premiums attributable to coverage for certain abortion services;
proposes to expand the annual open enrollment period and Navigator duties;
proposes a new monthly special enrollment period for qualified individuals or enrollees, or the dependents of a qualified individual or enrollee, who are eligible for advance payments of the premium tax credit APTC and whose household income does not exceed 150 percent of the federal poverty level FPL; proposes to repeal the recent establishment of a Direct Enrollment option for Exchanges;
and proposes to modify regulations and policies related to section 1332 waivers.
DATES: To be assured consideration, comments must be received at one of the addresses provided below, by July 28, 2021.
ADDRESSES: In commenting, please refer to file code CMS9906P.
Comments, including mass comment submissions, must be submitted in one of the following three ways please choose only one of the ways listed:
1. Electronically. You may submit electronic comments on this regulation to http www.regulations.gov. Follow the Submit a comment instructions.
2. By regular mail. You may mail written comments to the following
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SUMMARY:

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address ONLY: Centers for Medicare &
Medicaid Services, Department of Health and Human Services, Attention:
CMS9906P, P.O. Box 8016, Baltimore, MD 212448016.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS9906P, Mail Stop C42605, 7500 Security Boulevard, Baltimore, MD 212441850.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Alper Ozinal, 301 4924178, Adrianne Patterson, 410 7864178, Jacquelyn Rudich, 301 4925211, or Nora Simmons, 410 7861981, for general information.
Gian Johnson, 301 4924323, or Meredyth Woody, 301 4924404, for matters related to Navigator program standards.
Robert Yates, 301 4925151, for matters related to the Exchange Direct Enrollment option for Federallyfacilitated Exchanges, State-based Exchanges on the Federal platform, and State Exchanges.
Carly Rhyne, 301 4924188, or Aziz Sandhu, 301 4924437, for matters related to open enrollment.
Carolyn Kraemer, 301 4924197, for matters related to special enrollment periods for Exchange enrollment under parts 147 and 155.
Nikolas Berkobien, 989 3951836, for matters related to standardized options.
Aaron Franz, 410 7868027, or Nora Simmons, 410 7861981, for matters related to user fees.
Rebecca Bucchieri, 301 4924341, for matters related to provision of essential health benefits and separate billing and segregation of funds for abortion services.
Erika Melman, 301 4924348, Deborah Hunter, 410 7860625, or Emily Martin, 301 4924400, for matters related to network adequacy.
Lina Rashid, 202 2606098, Michelle Koltov, 301 4924225, or Kimberly Koch, 202 6220854 for matters related to section 1332 waivers.
SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in
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a comment. We post comments received before the close of the comment period on the following website as soon as possible after they have been received:
http www.regulations.gov. Follow the search instructions on that website to view public comments. CMS will not post on Regulations.gov public comments that make threats to individuals or institutions or suggest that the individual will take actions to harm the individual. CMS continues to encourage individuals not to submit duplicative comments. We will post acceptable comments from multiple unique commenters even if the content is identical or nearly identical to other comments.
Table of Contents I. Executive Summary II. Background A. Legislative and Regulatory Overview B. Stakeholder Consultation and Input C. Structure of Proposed Rule III. Provisions of the Updating Payment Parameters and Improving Health Insurance Markets for 2022 and Beyond Proposed Rule A. Part 147Health Insurance Reform Requirements for the Group and Individual Health Insurance Markets B. Part 155Exchange Establishment Standards and Other Related Standards Under the Affordable Care Act C. Part 156Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges IV. Provisions of the Proposed Rule for Section 1332 Waivers A. 31 CFR Part 33 and 45 CFR Part 155
Section 1332 Waivers V. Collection of Information Requirements A. ICRs Regarding Navigator Program Standards 155.210
B. ICRs Regarding Segregation of Funds for Abortion Services 156.280
C. ICRs Regarding Section 1332 Waivers 31 CFR Part 33 and 45 CFR Part 155
D. Submission of PRA Related Comments VI. Response to Comments VII. Regulatory Impact Analysis A. Statement of Need B. Overall Impact C. Impact Estimates of the Payment Notice Provisions and Accounting Table D. Regulatory Alternatives Considered E. Regulatory Flexibility Act F. Unfunded Mandates G. Federalism H. Congressional Review Act
I. Executive Summary American Health Benefit Exchanges, or Exchanges, are entities established under the Patient Protection and Affordable Care Act ACA 1 through 1 The Patient Protection and Affordable Care Act Pub. L. 111148 was enacted on March 23, 2010.
The Healthcare and Education Reconciliation Act of 2010 Pub. L. 111152, which amended and revised several provisions of the Patient Protection
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