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Federal Register / Vol. 86, No. 127 / Wednesday, July 7, 2021 / Rules and Regulations This premium policy is required by state law and included in Minnesotas BHP Blueprint.4
C. Federal BHP Payment Rate Cells In this section of the 2022 proposed BHP Payment Notice, we proposed to continue to require that a state implementing BHP provide us with an estimate of the number of BHP enrollees it will enroll in the upcoming BHP
program quarter, by applicable rate cell, to determine the federal BHP payment amounts. For each state, we proposed using rate cells that separate the BHP
population into separate cells based on the following factors: Age, geographic rating area, coverage status, household size, and income. For specific discussions of these proposals, please refer to the 2022 proposed BHP Payment Notice.
We received no comments on this aspect of the proposed methodology.
Therefore, we are finalizing these policies as proposed.
D. Sources and State Data Considerations We proposed in this section of the 2022 proposed BHP Payment Notice to continue to use, to the extent possible, data submitted to the federal government by QHP issuers seeking to offer coverage through an Exchange that uses HealthCare.gov to determine the federal BHP payment cell rates.
However, for states operating a Statebased Exchange SBE, which do not use HealthCare.gov, we proposed to continue to require such states to submit required data for CMS to calculate the federal BHP payment rates in those states. For specific discussions, please refer to the 2022 proposed BHP Payment Notice.
We received no comments on this aspect of the proposed methodology.
Therefore, we are finalizing these policies as proposed.

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E. Discussion of Specific Variables Used in Payment Equations In this section of the 2022 proposed BHP Payment Notice, we proposed to continue to use eight specific variables in the payment equations that compose the overall BHP funding methodology seven variables are described in section III.D. of this final notice, and the premium trend factor is described in section III.E. of this final notice. For each proposed variable, we included a discussion on the assumptions and data sources used in developing the variables. For specific discussions, 4 Minnesota
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please refer to 2022 proposed BHP
Payment Notice.
Below is a summary of the public comments we received regarding specific factors and our responses.
Comment: One commenter supported maintaining the value of the premium adjustment factor PAF at 1.188 for program year 2022.
Response: We appreciate the support from this commenter. As described further in this final notice, we are finalizing the methodology as proposed in the 2022 proposed BHP Payment Notice, and will be maintaining the value of the PAF at 1.188 for program year 2022.
Comment: One commenter expressed their support of using 2019 data to calculate the MTSF as proposed in the 2022 proposed BHP Payment Notice.
This commenter stated that using partial 2020 data to calculate the MTSF would likely not be a reasonable predictor of consumer behavior in 2022 due to the impact of the COVID19 public health emergency PHE.
Response: We appreciate the support from this commenter. However, since publication of the 2022 proposed Payment Notice, Congress passed the ARP, which, as discussed in section I.C.
of this final notice, modifies the applicable percentages of household income used to calculate the amount of APTC taxpayers are eligible to have paid on their behalf for coverage purchased through an Exchange during taxable years 2021 and 2022. We believe that these changes are likely to significantly affect enrollees plan choices starting in 2022. For this reason and the reasons discussed in sections I.C. and III.D.6. of this final notice, we are not finalizing inclusion of the MTSF in the 2022 final BHP Payment Notice.

using state-specific premiums and giving states the choice of applying actual current year premiums or the prior years premiums multiplied by the premium trend factor PTF. Due to the annual timing of this decision, this choice allows the state flexibility in making a determination that it believes is consistent with program goals for the upcoming year.
Response: We appreciate the support from this commenter. As described further in this final notice, we are finalizing the methodology as proposed in the 2022 proposed BHP Payment Notice.

F. State Option To Use Prior Program Year QHP Premiums for BHP Payments In this section of the 2022 BHP
proposed Payment Notice, we proposed to continue to provide states operating a BHP with the option to use the 2021
QHP premiums multiplied by a premium trend factor to calculate the federal BHP payment rates instead of using the 2022 QHP premiums. We proposed to require states to make their election for the 2022 program year by May 15, 2021, or within 60 days of publication of the final payment methodology, whichever is later. For specific discussions, please refer to the 2022 BHP proposed Payment Notice.
Below is a summary of the public comments we received regarding this section and our responses.
Comment: One commenter expressed support for the proposed approach of
III. Provisions of the 2022 BHP Final Methodology
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G. State Option To Include Retrospective State-Specific Health Risk Adjustment in Certified Methodology In this section of the 2022 BHP
proposed Payment Methodology, we proposed to provide states implementing BHP the option to develop a methodology to account for the impact that including the BHP
population in the Exchange would have had on QHP premiums based on any differences in health status between the BHP population and persons enrolled through the Exchange. We proposed that states would submit their optional protocol to CMS by the later of August 1, 2021 or 60 days after the publication of the final methodology. For specific discussions, please refer to the 2022
BHP proposed Payment Notice.
We received no comments on this aspect of the methodology. Therefore, we are finalizing this policy as proposed. Because we are finalizing the 2022 payment methodology within 60
days of August 1, 2021, a state electing this option must submit their protocol to CMS within 60 days of publication of this final notice.

A. Overview of the Funding Methodology and Calculation of the Payment Amount Section 1331d3 of the Patient Protection and Affordable Care Act directs the Secretary to consider several factors when determining the federal BHP payment amount, which, as specified in the statute, must equal 95
percent of the value of the PTC and CSRs that BHP enrollees would have been provided had they enrolled in a QHP through an Exchange. Thus, the BHP funding methodology is designed to calculate the PTC and CSRs as consistently as possible and in general alignment with the methodology used by Exchanges to calculate APTC and CSRs, and by the IRS to calculate PTC

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