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Federal Register / Vol. 86, No. 127 / Wednesday, July 7, 2021 / Rules and Regulations Equation 2a and Equation 2b:
Adjusted Reference Premium Variable Used in Equation 1
As part of the calculations for the PTC
component, we will calculate the value of the adjusted reference premium as described below. Consistent with the existing approach, we will allow states to choose between using the actual current year premiums or the prior years premiums multiplied by the PTF
as described in section III.E. of this final methodology. Below we describe how we will calculate the adjusted reference premium under each option.
In the case of a state that elected to use the reference premium RP based on the current program year for example, 2022 premiums for the 2022

Equation 2a: ARPa,g,c
In the case of a state that elected to use the RP based on the prior program year for example, 2021 premiums for the 2022 program year, as described in
more detail in section II.E. of this final methodology, we will calculate the value of the adjusted reference premium as specified in Equation 2b. The adjusted reference premium will be equal to the RP, which will be based on the second lowest cost silver plan premium in 2021, multiplied by the BHP PHF described in section III.D.3.
of this final methodology, which will reflect the projected impact that enrolling BHP-eligible individuals in
Equation 2b: ARPa,g,c ARPa,g,c = Adjusted reference premium a = Age range g = Geographic area c = Coverage status self-only or applicable category of family coverage obtained through BHP
RPa,g,c = Reference premium PHF = Population health factor PAF = Premium adjustment factor
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=

X

PAF

QHPs on an Exchange would have had on the average QHP premium, multiplied by the PAF described in section III.D.2. of this final methodology, which will account for the change in silver-level premiums due to the discontinuance of CSR payments, and multiplied by the PTF described in section III.E. of this final methodology, which would reflect the projected change in the premium level between 2021 and 2022.

RPa,g,c x PHF x PAF x PTF

PTF = Premium trend factor
Equation 3: Determination of Total Monthly Payment for BHP Enrollees in Each Rate Cell
BHP enrollees in that cell that is, the number of enrollees that meet the criteria for each rate cell to calculate the total monthly BHP payment. This calculation is shown in Equation 3.

In general, the rate for each rate cell will be multiplied by the number of
Equation 3: PMT
PMT = Total monthly BHP payment PTCa,g,c,h,i = Premium tax credit portion of BHP payment rate CSRa,g,c,h,i = Cost sharing reduction portion of BHP payment rate Ea,g,c,h,i = Number of BHP enrollees a = Age range g = Geographic area c = Coverage status self-only or applicable category of family coverage obtained through BHP
h = Household size i = Income range as percentage of FPL

= RPa,g,c X PHF

= LPTCa,g,c,h,i + CSRa,g,c,h,i X Ea,g,c,h,d
In this equation, we will assign a value of zero to the CSR part of the BHP
payment rate calculation CSRa,g,c,h,i because there is presently no available appropriation from which we can make the CSR portion of any BHP payment. In the event that an appropriation for CSRs for 2022 is made, we will determine whether and how to modify the CSR
part of the BHP payment rate calculation CSRa,g,c,h,i or the PAF in the payment methodology.

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B. Federal BHP Payment Rate Cells Consistent with the previous payment methodologies, a state implementing a BHP will provide us an estimate of the number of BHP enrollees it projects will enroll in the upcoming BHP program quarter, by applicable rate cell, prior to the first quarter and each subsequent quarter of program operations until actual enrollment data is available.
Upon our approval of such estimates as reasonable, we will use those estimates
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ARPa,g,c = Adjusted reference premium a = Age range g = Geographic area c = Coverage status self-only or applicable category of family coverage obtained through BHP
RPa,g,c = Reference premium PHF = Population health factor PAF = Premium adjustment factor
program year, we will calculate the value of the adjusted reference premium as specified in Equation 2a. The adjusted reference premium will be equal to the RP, which will be based on the second lowest cost silver plan premium in the applicable program year, multiplied by the BHP population health factor PHF described in section III.D.3. of this final methodology, which will reflect the projected impact that enrolling BHP-eligible individuals in QHPs through an Exchange would have had on the average QHP premium, and multiplied by the PAF described in section III.D.2. of this final methodology, which will account for the change in silver-level premiums due to the discontinuance of CSR payments.

ER07JY21.072

PTCa,g,c,h,i = Premium tax credit portion of BHP payment rate a = Age range g = Geographic area c = Coverage status self-only or applicable category of family coverage obtained through BHP
h = Household size i = Income range as percentage of FPL
ARPa,g,c = Adjusted reference premium Ih,i,j = Income in dollars per month at each 1 percentage-point increment of FPL
j = jth percentage-point increment FPL
n = Number of income increments used to calculate the mean PTC
PTCFh,i,j = Premium tax credit formula percentage IRF = Income reconciliation factor
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