Voglio sapere a riguardo di…

35626

Federal Register / Vol. 86, No. 127 / Wednesday, July 7, 2021 / Rules and Regulations
enrolled in QHPs, we are not requiring that a BHPs standard health plans receive such payments. As explained in the BHP final rule, BHP standard health plans are not included in the federallyoperated risk adjustment program.14
Further, standard health plans did not qualify for payments under the transitional reinsurance program established under section 1341 of the Patient Protection and Affordable Care Act for the years the program was operational 2014 through 2016.15 To the extent that a state operating a BHP
determines that, because of the distinctive risk profile of BHP-eligible consumers, BHP standard health plans should be included in mechanisms that share risk with other plans in the states individual market, the state would need to use other methods for achieving this goal.
4. Household Income I
Household income is a significant determinant of the amount of the PTC
that is provided for persons enrolled in a QHP through an Exchange.
Accordingly, all BHP Payment Methodologies incorporate household income into the calculations of the payment rates through the use of income-based rate cells. We are finalizing our proposal to define household income in accordance with the definition of modified adjusted gross income in 26 U.S.C. 36Bd2B and consistent with the definition in 45 CFR
155.300. Income will be measured relative to the FPL, which is updated periodically in the Federal Register by the Secretary under the authority of 42
U.S.C. 99022. Household size and income as a percentage of FPL will be used as factors in developing the rate cells. We are finalizing our proposal to use the following income ranges measured as a percentage of FPL: 16
050 percent.
51100 percent.
101138 percent.
139150 percent.
151175 percent.
176200 percent.

We will assume a uniform income distribution for each federal BHP
payment cell. We believe that assuming a uniform income distribution for the income ranges finalized will be reasonably accurate for the purposes of calculating the BHP payment and would avoid potential errors that could result if other sources of data were used to estimate the specific income distribution of persons who are eligible for or enrolled in the BHP within rate cells that may be relatively small.
Thus, when calculating the mean, or average, PTC for a rate cell, we will calculate the value of the PTC at each one percentage point interval of the income range for each federal BHP
payment cell and then calculate the average of the PTC across all intervals.
This calculation would rely on the PTC
formula described in section III.D.5. of this final methodology.
As the APTC for persons enrolled in QHPs would be calculated based on their household income during the open enrollment period, and that income would be measured against the FPL at that time, we will adjust the FPL by multiplying the FPL by a projected increase in the CPIU between the time that the BHP payment rates are calculated and the QHP open enrollment period, if the FPL is expected to be updated during that time.
The projected increase in the CPIU will be based on the intermediate inflation forecasts from the most recent Old-Age, Survivors, and Disability Insurance OASDI and Medicare Trustees Reports.17
5. Premium Tax Credit Formula PTCF
In Equation 1 described in section III.A.1. of this final methodology, we will use the formula described in 26
U.S.C. 36Bb to calculate the estimated PTC that would be paid on behalf of a person enrolled in a QHP on an Exchange as part of the BHP payment methodology. This formula is used to determine the contribution amount the amount of premium that an individual or household theoretically would be required to pay for coverage in a QHP

on an Exchange, which is based on A
the household income; B the household income as a percentage of FPL for the family size; and C the schedule specified in 26 U.S.C.
36Bb3A and shown below.
The difference between the contribution amount and the adjusted monthly premium that is, the monthly premium adjusted for the age of the enrollee for the applicable second lowest cost silver plan is the estimated amount of the PTC that would be provided for the enrollee.
The PTC amount provided for a person enrolled in a QHP through an Exchange is calculated in accordance with the methodology described in 26
U.S.C. 36Bb2. The amount is equal to the lesser of the premium for the plan in which the person or household enrolls, or the adjusted premium for the applicable second lowest cost silver plan minus the contribution amount.
The applicable percentage is defined in 26 U.S.C. 36Bb3A and 26 CFR
1.36B3g as the percentage that applies to a taxpayers household income that is within an income tier specified in Table 1, increasing on a sliding scale in a linear manner from an initial premium percentage to a final premium percentage specified in Table 1. We are finalizing our proposal to continue to use applicable percentages to calculate the estimated PTC that would be paid on behalf of a person enrolled in a QHP on an Exchange as part of the BHP payment methodology as part of Equation 1.
As discussed in section I.C. of this final notice, we note that the ARP
updated the applicable percentages of household income used to calculate the PTC that would be paid to an individual enrolled in a QHP on an Exchange for calendar years CY 2021 and 2022. The applicable percentages in Table 1 for CY
2022 will be effective for BHP program year 2022. Absent future legislation addressing applicable percentages, applicable percentages will be updated in future years in accordance with 26
U.S.C. 36Bb3Aii.

TABLE 1APPLICABLE PERCENTAGE TABLE FOR CY 2022 a
khammond on DSKJM1Z7X2PROD with RULES

In the case of household income expressed as a percent of poverty line within the following income tier:

The initial premium percentage is
Up to 150%
150.0% percent up to 200.0%
14 See
79 FR at 14131.
45 CFR 153.400a2iv BHP standard health plans are not required to submit reinsurance contributions, 153.20 definition of Reinsuranceeligible plan as not including health insurance coverage not required to submit reinsurance 15 See
VerDate Sep<11>2014

15:58 Jul 06, 2021

Jkt 253001

contributions, 153.230a reinsurance payments under the national reinsurance parameters are available only for Reinsurance-eligible plans.
16 These income ranges and this analysis of income apply to the calculation of the PTC.

PO 00000

Frm 00032

Fmt 4700

Sfmt 4700

0.0
0.0

The final premium percentage is 0.0
2.0

17 See Table IV A1 from the 2020 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, available at https
www.cms.gov/files/document/2020-medicaretrustees-report.pdf.

E:FRFM07JYR1.SGM

07JYR1