They also cannot refuse coverage or charge more for . 2018 Benefit Year Risk Adjustment: HHS-Developed Risk Adjustment Model Algorithm Do it Yourself (DIY) Software, *Document now links to revised version published on May 12, 2020 PDF Policy and Operational Guide for Planning and Implementing Firm Publication On November 2, 2022, the Centers for Medicare & Medicaid Services (CMS) filed its Medicare Physician Fee Schedule (PFS) final rule (Final Rule) for calendar year (CY) 2023. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. ( CY 2024 Medicare Hospital Outpatient Prospective Payment System and Category 3 telehealth services will be covered through 2023. These billing guidelines will remain in effect until new rules are adopted by ODM following the public health emergency. Patient consent for GBHI1 is independently required when it is provided concurrently with other care management services. AMA telehealth policy, coding & payment Were happy to help with this! The change goes into effect on January 1, 2023. Notice: July 2023 Rate Updates Medicaid State Plan Amendment 23-0041 Public Notice is now available online. In the Spring of 2022, the Centers for Medicare and Medicaid Services (CMS) released its 2022 Behavioral Health Strategy (the BH Strategy) to increase access to care and improve patient outcomes. amends the direct supervision requirement under CMS incident to regulation at 42 CFR 410.26 to allow behavioral health services to be furnished by clinical staff under the general supervision of a physician or non-physician practitioner (NPP), so long as CMS incident to requirements and state licensure requirements are met. You can decide how often to receive updates. Jane Zhu, M.D. NDC search. Medicaid renewals began again in Rhode Island on April 1, 2023. amends the direct supervision requirement under CMS' "incident to" regulation at 42 CFR . PEB Board approves Medicare premiums and reviews other premiums First, CMS updated the methodology to determine the reimbursement rate for methadone (a frequently prescribed drug for serious opioid use dependence). MENTAL HEALTH SERVICES BILLING GUIDE . CSWs will only be able to bill for GBHI1 when they personally furnish the services. Please read Quick Tip 221 for additional information. COVID-19 Telehealth and Remote Monitoring Resources, Virtual Care Management Compliance Assessment. MHCP fee schedule. In response to the increased demand for mental health services, CMS has also made an exception to the direct supervision requirement under the "incident to" regulation. Because the scopes of practice for CPs and CSWs differ significantly from those of physicians and NPPs, CMS plans to allow CPT code 90791, an integrated biopsychosocial assessment, to serve as the initiating visit for GBHI1. Use 90834 for sessions lasting from 38 to 52 minutes. These services and treatments span a wide range of necessary components to ensure a smooth process. The conversion factor is a variable that is multiplied by the relative value unit (RVU) assigned to every physician service or . Visit our Forms and publications page to download authorization forms. Mental health company Health Connect America will pay more than $4.6 million "to resolve allegations that it billed Virginia Medicaid for services not . Use 90832 for sessions that run between 16 and 37 minutes. Provider billing guides and fee schedules | Washington State Health Parenting is one of the most complex and challenging jobs you'll face in your lifetime -- but also the most rewarding. Short-Term Health Insurance, Medical Debt And Billing Are Complete Guide to Mental Health Billing - ICANotes Rehabilitative Services Coverage Guidelines | Executive Office of In response to stakeholder feedback, clinical data, scientific evidence, and the increased need for mental health services, CMS is creating a new G-code for 2023 to allow CPs and CSWs to furnish and bill for BHI when they are the patients primary treating clinician for covered behavioral health services. 2023 Telehealth Billing Guide for Medicare Fee-For-Service means youve safely connected to the .gov website. New laws took effect July 1 in states across the country. What to know CMS recognizes the COVID-19 PHE has increased the demand for behavioral health services and increased the barriers to care access. The 2023 Mental Health Services Conference; Addressing Structural Racism Town Hall Series; APA Meetings App; . Requirements for Mental and Behavioral Health Services - New HCPCS code for Behavioral Health Integration (BHI) . Medicare began paying for these in 2020. Effective January 2023, both codes will be assigned an "A" for active status. Health & Parenting Guide - Your Guide to Raising a Happy Entities that relied on the information in previous appendices willnot be penalized. A completed Rhode Island Medicaid Prior Authorization Request Form. "Behavior Management Services" - New Guidelines and Parenthetical Notes - Two (2) New CPT Codes created to describe . Study finds scant mental health care coverage for older adults Updated Federal Standard Renewal and Product Discontinuation Notices, and Enforcement Safe Harbor for Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the Individual Market in the 2024 Benefit Year. Use the billing guides and fee schedules to find rate information and the ProviderOne Billing and Resource Guide to walk through the claims process. An official website of the United States government Updated with minor corrections to the information posted January13, 2017. PDF MENTAL HEALTH SERVICES BILLING GUIDE - home.nyc.gov 09-90-0250), CMS-9996-N ERRP Program Notice to Stop Accepting Applications, CMS-9996-N2: Early Retiree Reinsurance Program Notice regarding Incurred Claims Date, CMS-9996-N3: Early Retiree Reinsurance Program Notice regarding the Date by which Plan Sponsors Must Use Funds, Explanation of the Appeal Process for the Early Retiree Reinsurance Program (PDF), CMS-9996-N4: Early Retiree Reinsurance Program Notice regarding Termination of Several Operational Processes, Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-FWP) and Standards Related to Reinsurance Risk Corridors and Risk Adjustment (CMS-9975-F) (PDF), CMS-9957-F: Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility Appeals, CMS-9957-F2: Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to HHS Notice of Benefit and Payment Parameters for 2014, CMS-9945-IFC: Patient Protection and Affordable Care Act; Maximizing January 1, 2014 Coverage Opportunities, CMS-9957-CN: Patient Protection and Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to HHS Notice of Benefit and Payment Parameters for 2014 Correction, CMS-9941-P: Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges (PDF), CMS-9941-F: Patient Protection and Affordable Care Act; Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs; Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges (PDF), CMS-9933-IFC: Patient Protection and Affordable Care Act; Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program, CMS-3337-IFC: Conditions for Coverage for End-Stage Renal Disease Facilities, CMS-9929-P: Patient Protection and Affordable Care Act; Market Stabilization Proposed Rule, CMS-9929-F: Patient Protection and Affordable Care Act; Market Stabilization Final Rule, CMS-9922-P: Patient Protection and Affordable Care Act; Exchange Program Integrity, Exchange and Medicaid Information Technology (IT) Systems (PDF), Guidance for Exchange and Medicaid Information Technology (IT) Systems: Version 2.0 (PDF), State Exchange Implementation Questions and Answers (PDF), Verification of Access to Employer-Sponsored Coverage Bulletin (PDF), General Guidance on Federally-facilitated Exchanges (PDF), Exchanges, Market Reforms and Medicaid Frequently Asked Questions (PDF), Guidance on State Partnership Exchange (PDF), Draft 2014 Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF), 2014 Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF), Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces (PDF), Small Business Health Options Program (SHOP)-Only Marketplace (PDF), Guidance on State Alternative Applications for Health Coverage (PDF), Guidance on Hardship Exemption Criteria and Special Enrollment Periods (PDF), Guidance on Certified Application Counselor Program for the Federally Facilitated Marketplace including State Partnership Marketplaces, Sample Application: Apply to be a Certified Application Counselor (CAC) Organization, Guidance on State Alternative Applications for Health Coverage through the Small Business Health Options Program (SHOP), Guidance on Internal Revenue Ruling 2013-17 and Eligibility for Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions (PDF), Federally Facilitated Marketplace Enrollment Operational Policy & Guidance (PDF), The Sale of Individual Market Policies to Medicare Beneficiaries Under 65 Losing Coverage Due to High Risk Pool Closures (PDF), Frequently Asked Questions on the Sale of Individual Market Policies to Medicare Beneficiaries Under 65 Losing Coverage Due to High Risk Pool Closures (PDF), Draft 2015 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), MS Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances (PDF), Casework Guidance for Issuers in Federally-facilitated Marketplaces, including State Partnership Market Places (PDF), 015 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Guidance for Issues on People "In Line" for the Federally-facilitated Marketplace at the end of the Initial Open Enrollment Period (PDF), Guidance for Issues on Special Enrollment Periods for Complex Cases in the Federally-facilitated Marketplace after the Initial Open Enrollment Period (PDF), Shared Responsibility Provision Question and Answer (PDF), Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria (PDF), Guidance on Annual Redeterminations for Coverage for 2015 (PDF), Shared Responsibility Guidance Filing Threshold Hardship Exemption (PDF), hared Responsibility Guidance Exemption for Individuals Eligible for Services through an Indian Health Care Provider (PDF), Guidance on Hardship Exemptions, Age Offs, and Renewal of Catastrophic Coverage (PDF), Guidance for Issuers on the Termination of a Consumers Enrollment in the Federally-facilitated Marketplace Due to Death (PDF), Guidance on Hardship Exemptions for Persons Meeting Certain Criteria (PDF), Guidance for Issuers on 2015 Reenrollment in the Federally-facilitated Marketplace (PDF), Draft 2016 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Final 2016 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Guidance for Ending Special Enrollment Periods for Coverage during Calendar Year 2014 (PDF), Guidance on Annual Eligibility Re-determinations and Re-enrollments for Marketplace Coverage for 2016 (PDF), MS Bulletin on Proposed Out-Of-Pocket (OOP) Cost Comparison Tool for the Federally-facilitated Marketplaces (FFMs) (PDF), Distribution of Information Regarding Advance Payments of the Premium Tax Credit (APTC) and Cost-Sharing Reductions (CSR) in Federal Standard Notices for Coverage Offered through the Federally-facilitated Marketplaces (PDF), Updated Guidance on Victims of Domestic Abuse and Spousal Abandonment (PDF), Guidance for Issuers on 2016 Reenrollment in the Federally-facilitated Marketplace (FFM) (PDF), Federally-facilitated Marketplace and Federally-facilitated Small Business Health Options Program Enrollment Manual (PDF), CMS Final Bulletin on Out-of-Pocket (OOP) Cost Comparison Tool for the Federally-facilitated Marketplaces (FFMs) (PDF), Issuer Guidance for Handling 2015 Unaffiliated Issuer Enrollments and Clarification to Section V of Bulletin 16: Guidance for Issuers on 2016 Reenrollment in the Federally-Facilitated Marketplaces (PDF), Policy-Based Payments Bulletin: Approach to 2016 Marketplace Payment Program Integrity, Withholding for Issuers Delayed on Policy-Based Payments Implementation, and Payment Adjustment for Issuers Deemed Policy-Based Payments Ready (PDF), Draft 2017 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Final 2017 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Policy-Based Payments: April 2016 Transition of All Issuers to Policy-based Payments and Subsequent Adjustments Only in Cases of Extreme Variation Between Policy-based Payments and the Manual Payment Process (PDF), Guidance for Ending Special Enrollment Periods for Coverage during Calendar Year 2015 (PDF), Extension of State-based SHOP Direct Enrollment Transition (PDF), Policy-Based Payments: Reversal of January 2016 April 2016 Adjustments in the May and June Payment Cycles (PDF), Guidance on Annual Eligibility Redetermination and Re-enrollment for Marketplace Coverage for 2017 (PDF), Effectuation of 2016 Federally-Facilitated Marketplace Dental Enrollment INFORMATION (PDF), Guidance for State-based Marketplaces No Cost Extensions in 2017 (PDF), Federally-facilitated Marketplace (FFM) and Federally-facilitated Small Business Health Options Program (FF-SHOP) Enrollment Manual (PDF), Guidance on Health Coverage Tax Credit Hardship Exemption (PDF), CMS Bulletin on Network Breadth Information for Qualified Health Plans on Healthcare.gov (PDF), Frequently Asked Questions Regarding Verification of Special Enrollment Periods (PDF), Updated CMS Bulletin on Network Breadth Information for Qualified Health Plans on HealthCare.gov (PDF), Draft 2018 Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Policy-Based Payments Bulletin: Temporary Manual Adjustment - Easing Cash Flow Impact of the 2017 Transition for Issuers on Policy-Based Payments (PDF), Final 2018 Letter to Issuers in the Federally-facilitated Marketplaces and February 17 Addendum (PDF), Guidance for Ending Special Enrollment Periods for Coverage during Calendar Year 2016 (PDF), The Future of the SHOP: CMS Intends to Allow Small Businesses in SHOPs Using HealthCare.gov More Flexibility when Enrolling in Healthcare Coverage (PDF), Guidance for the Proxy Direct Enrollment Pathway for 2018 Individual Market Open Enrollment Period (PDF), Display of 2017 Quality Rating System (QRS) star ratings and Qualified Health Plan (QHP) Enrollee Experience Survey results for QHPs offered through the Health Insurance Exchanges (PDF), State Based Exchange on the Federal Platform (SBE-FP) User Fee Collection Process Technical Guidance for States (PDF), Guidelines for Third-party Auditor Operational Readiness Reviews for the Proxy Direct Enrollment Pathway (PDF), Guidance: Annual Eligibility Redetermination and Re-enrollment for Exchange Coverage for 2018 (PDF), Guidance: 2017 Hurricane Disasters Special Enrollment Periods (SEPs), Termination of Coverage, and Grace Period Flexibilities (PDF), CMS to Allow Small Businesses and Issuers New Flexibilities in the Small Business Health Options Program (SHOP) For Plan Year 2018 (PDF), Draft 2019 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Availability of Marketplace Special Enrollment Period for Individuals Affected by Hurricanes in Puerto Rico and US Virgin Islands (PDF), Guidelines for Third-party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Related Oversight Requirements (PDF), Final 2019 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Guidance on Hardship Exemptions from the Individual Shared Responsibility Provision for Persons Experiencing Limited Issuer Options or Other Circumstances (PDF), Guidance for Ending Special Enrollment Periods for Coverage during Calendar Year 2017 (PDF), Guidance on Annual Eligibility Redetermination and Re-enrollment for Exchange Coverage for 2019 and Later Years (PDF), Federally-facilitated Exchange and Federally-facilitated Small Business Health Options Program Enrollment Manual (PDF), Emergency and Major Disaster Declarations by the Federal Emergency Management Agency (FEMA) Special Enrollment Periods (SEPs), Termination of Coverage, and Payment Deadline Flexibilities, Effective August 9, 2018 (PDF), Guidance on Claiming a Hardship Exemption through the Internal Revenue Service (IRS) (PDF), Display of 2018 Quality Rating System (QRS) star ratings and Qualified Health Plan (QHP) Enrollee Experience Survey results for QHPs offered through the Health Insurance Exchanges (PDF), Availability of Additional Special Enrollment Period for Certain Individuals Affected by Hurricane Michael in Florida and Georgia (PDF), Draft 2020 Letter to Issuers on Federally-facilitated Exchanges (PDF), Guidelines for Third-party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment Pathway and Related Oversight Requirements - PY 2019 and PY 2020 (PDF), Submission Deadline for Applicants Seeking Prior Year Coverage through Special Enrollment Periods (PDF), Final 2020 Letter to Issuers on Federally-facilitated Exchanges (PDF), Key Priorities for Federally-Facilitated Exchange (FFE) Web-broker Direct Enrollment (DE) Compliance Reviews for Plan Year 2019 (PDF), Quality Rating Information Bulletin for Plan Year 2020 (PDF), Guidance on Updated Direct Enrollment (DE) Web-broker Program Participation Requirements (PDF), Draft 2021 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Guidelines for Third-party Auditor Operational Readiness Reviewsfor the Enhanced Direct Enrollment Pathway andRelated OversightRequirements - PY 2020 and PY 2021 Year 3 (PDF), FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation (PDF), Final 2021 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Quality Rating System (QRS), Qualified Health Plan (QHP) Enrollee Experience Survey, and Quality Improvement Strategy (QIS) FAQs in Response to the Coronavirus (COVID-19) Pandemic (PDF), Direct Enrollment Entity Standards of Conduct Website Display Guidance (PDF), Key Priorities for Federally-Facilitated Exchange (FFE) and State-based Exchange on the Federal Platform (SBE-FP) Direct Enrollment (DE) Compliance Reviews for Plan Year 2020 (PDF), Leveraging Existing Health and Disease Management Programs to Provide Mental Health and Substance Use Disorder Resources During the COVID-19 Public Health Emergency (PHE) (PDF), Enrollment Manual for Federally-facilitated Exchange and Federally-facilitated Small Business Health Options Program (PDF), Draft 2022Letter to Issuers in the Federally-facilitated Marketplaces (PDF), Frequently Asked Question (FAQ) Regarding the 2021 Audit Submission Timeline for Third-party Auditor Operational Readiness Reviews for the Enhanced Direct Enrollment (EDE) Pathway (PDF), Updated - 2021 Special Enrollment Period (SEP) Current Schedule of Planned Maintenance (PDF), Updated - 2021 Special Enrollment Period for COVID-19 Public Health Emergency Technical Stakeholder Guidance (PDF), Final 2022 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Failure to File and Reconcile (FTR) Operations Flexibilities for Plan Years 2021 and 2022 Frequently Asked Questions (FAQ) (PDF), Annual Income Threshold Adjustment FAQ (PDF), Draft 2023 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Draft 2023 Letter to Issuers in the Federally-facilitated Exchanges Extension of Comment Period (PDF), Final 2023 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Failure to File and Reconcile (FTR) Operations Flexibilities for Plan Year 2023 - Guidance (PDF), Clarifying Guidance on the Frequently Asked Questions on Agent and Broker Compensation and Guaranteed Availability of Coverage, Final 2024 Letter to Issuers in the Federally-facilitated Exchanges (PDF), Enrollment Manual for Federally-facilitated Exchange (PDF), CMS-9965-P: Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans, CMS-9965-F: Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans, CMS-9961-N: Recognition of Entities for the Accreditation of Qualified Health Plans, CMS-9980-F: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation, Additional Information on State EHB Benchmark Plans, 2014 Actuarial Value Calculator Methodology (PDF), Minimum Value Calculator Methodology (PDF), Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State (PDF), Frequently Asked Questions on the Essential Health Benefits Bulletin (PDF), Actuarial Value and Cost-Sharing Reductions Bulletin (PDF), Essential Health Benefits: List of the Largest Three Small Group Products by State (PDF), Issuers of Stand-alone Dental Plans (PDF), State Evaluation of Plan Management Activities of Health Plans and Issuers (PDF), Notice with Comment: Quality Rating System (QRS), Framework Measures, and Methodology, tate Technical Assistance on State-Specific Data for Actuarial Value Calculator (PDF), Actuarial Value Calculator Continuance Tables, 016 Actuarial Value Calculator Methodology (PDF), Updated Essential Health Benefits: List of the Largest Three Small Group Products by State (PDF), List of Proposed 2017 EHB Benchmark Plans and Related Information, List of Final 2017 EHB Benchmark Plans and Related Information, 2017 Actuarial Value Calculator Methodology (PDF), CMS Bulletin on display of Quality Rating System (QRS) star ratings and Qualified Health Plan (QHP) Enrollee Survey results for QHPs offered through Marketplaces (PDF), UPDATE: CMS Quality Rating Information Bulletin (PDF), Notice to States Regarding Marketplace Auto Re-Enrollment (PDF), PY2017 QHP Issuer Certification and Privacy and Security Agreement (PDF), Frequently Asked Questions Regarding Crosswalk of Enrollees into Plans Offered by Other Issuers (PDF), AQ on Compliance Safe Harbor for Issuers Affected by an Increase in Enrollment for the 2017 Plan Year (PDF), 2018 Actuarial Value Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12), 2018 Actuarial Value Calculator Methodology (PDF), Guidance to States on Review of Qualified Health Plan Certification Standards in Federally-facilitated Marketplaces for Plan Years 2018 and Later (PDF), CMS Bulletin Addressing Enforcement of Section 1303 of the Patient Protection and Affordable Care Act (PDF), 2019 Actuarial Value Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12), 2019 Actuarial Value Calculator Methodology (PDF), 2020 Actuarial Value Calculator (VND.MS-EXCEL.SHEET.MACROENABLED.12), 2020 Actuarial Value Calculator Methodology (PDF), FAQ on 2020 QHP Enrollee Survey Sample Frame Reporting Requirements (PDF), ProposedQHP PY2022 Data Submission and Certification Timeline Bulletin (PDF), Draft 2022 Actuarial Value Calculator (XLSM), Draft 2022 Actuarial Value Calculator Methodology (PDF), PY2022 QHP Data Submission and Certification Timeline Bulletin (PDF), 2022 Actuarial Value Calculator Methodology (PDF), Draft 2023 Actuarial Value Calculator (XLSM), Draft 2023 Actuarial Value Calculator Methodology (PDF), PY2023 QHP Data Submission and Certification Timeline Bulletin (PDF), 2023 Actuarial Value Calculator Methodology (PDF), Revised: PY2023 QHP Data Submission and Certification Timeline Bulletin (PDF), Draft 2024 Actuarial Value Calculator (XLSM), Draft 2024 Actuarial Value Calculator Methodology (PDF), Proposed QHP PY2024 Data Submission and Certification Timeline Bulletin, PY2024 QHP Data Submission and Certification Timeline Bulletin (PDF), FAQs on Coverage of Abortion for which Public Funding is Prohibited by Qualified Health Plan (QHP) Issuers in the Individual Market (PDF), 2024 Actuarial Value Calculator Methodology (PDF), Harmonized Security and Privacy Framework Exchange Reference Architecture Supplement V1.0 (PDF), Minimum Acceptable Risk Standards for Exchanges Exchange Reference Architecture Supplement, V1.0 (PDF), Catalog of Minimum Acceptable Risk Controls for Exchanges Exchange Reference Architecture Supplement, V1.0 (PDF), Volume 1: MARS-E v2.0: Harmonized Security and Privacy Framework (PDF), Volume 2: MARS-E v2.0: Minimum Acceptable Risk Standards for Exchanges (PDF), Volume 3: MARS-E v2.0: Catalog of Security and Privacy Controls (PDF), Volume 4: MARS-E v2.0: ACA Administering Entity System Security Plan (PDF, MS-9975-P: Standards Related to Reinsurance, Risks Corridors and Risk Adjustment, CMS-9989-P2: Preliminary Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-P) and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (CMS-9975-P) (PDF), Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-FWP) and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (CMS-9975-F) (PDF), CMS-9954-P: Proposed HHS Notice of Benefit and Payment Parameters for 2015, CMS-9954-F: HHS Notice of Benefit and Payment Parameters for 2015, 015 Actuarial Value Calculator Methodology (PDF), CMS-9954-P: Proposed HHS Notice of Benefit and Payment Parameters for 2016, CMS-9944-F: Final HHS Notice of Benefit and Payment Parameters for 2016, CMS-9937-P: Proposed HHS Notice of Benefit and Payment Parameters for 2017, CMS-9937-F: Final HHS Notice of Benefit and Payment Parameters for 2017, CMS-9934-P: Proposed HHS Notice of Benefit and Payment Parameters for 2018, CMS-9934-F: Final HHS Notice of Benefit and Payment Parameters for 2018, CMS-9930-P: Proposed HHS Notice of Benefit and Payment Parameters for 2019, CMS-9930-F: Final HHS Notice of Benefit and Payment Parameters for 2019, Example of an Acceptable Methodology for Comparing Benefits of a States EHB-benchmark Plan Selection in Accordance with 45 CFR 156.111(b)(2)(i) and (ii) (PDF), 2019 Final HHS Risk Adjustment Model Coefficients (PDF), CMS- 9920-F: Adoption of the Methodology for the HHS-operated Permanent Risk Adjustment Program under the Patient Protection and Affordable Care Act for the 2017 Benefit Year, CMS- 9919-P: Patient Protection and Affordable Care Act; Methodology for the HHS-operated Permanent Risk Adjustment Program for 2018 Proposed Rule, CMS-9917-F: Patient Protection and Affordable Care Act; Elimination of Internal Agency Process for Implementation of the Federally-Facilitated User Fee Adjustment Final Rule, CMS-9919-F: Patient Protection and Affordable Care Act: Adoption of the Methodology for the HHS-Operated Permanent Risk Adjustment Program for the 2018 Benefit Year, final rule, CMS-9926-P: Proposed HHS Notice of Benefit and Payment Parameters for 2020, CMS-9926-F: Final HHS Notice of Benefit and Payment Parameters for 2020, CMS 9916-P: Proposed HHS Notice of Benefit and Payment Parameters for 2021, CMS 9916-F: FinalHHS Notice of Benefit and Payment Parameters for 2021, CMS-9913-F: Final Amendments to HHS-RADV (PDF), CMS 9914-P: Proposed HHS Notice of Benefit and Payment Parameters for 2022 (PDF), CMS 9914-F: Final HHS Notice of Benefit and Payment Parameters for 2022 (Part I), CMS 9914-F: Final HHS Notice of Benefit and Payment Parameters for 2022 (Part 2), CMS-9906-P: 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, CMS-9906-F: Patient Protection and Affordable Care Act; Updating Payment Parameters, Section 1332 Waiver Implementing Regulations, and Improving Health Insurance Markets for 2022 and Beyond Final Rule, CMS-9911-F: Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2023 (PDF), CMS-9899-P: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024, CMS-9899-F: Patient Protection and Affordable Care Act, HHS Notice of Benefit and Payment Parameters for 2024, Bulletin on the Risk Adjustment Program: Proposed Operations by the Department of Health and Human Services (PDF), Bulletin on the Transitional Reinsurance Program: Proposed Payment Operations by the Department of Health and Human Services (PDF), 2014 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), The Transitional Reinsurance Program: Availability of the ACA Transitional Reinsurance Program Annual Enrollment and Contributions Submission Form on Pay.gov (PDF), Transitional Reinsurance Programs Contribution Collections for the 2014 Benefit Year, Transitional Reinsurance Program Timing of Contributions Refund Requests (PDF), Transitional Adjustment for 2014 Risk Corridors Program (PDF), Evaluation of EDGE Data Submissions Bulletin (PDF), EDGE Data Submission Grace Period Bulletin (PDF), Preliminary Risk Corridors Program Results (PDF), Overview of Draft Fiscal Year 2016 ICD-10 Crosswalk for HHS-HCC Risk Adjustment Model (PDF), Draft Fiscal Year 2016 ICD-10 Crosswalk for HHS-HCC Risk Adjustment Model (XLSX), Adjustment of Risk Adjustment Transfers Due to Submission of Incorrect Data (PDF), Early Reinsurance Payments for the 2015 Benefit Year (PDF), 2015 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Risk Corridors Payments for the 2014 Benefit Year Guidance (PDF), Evaluation of EDGE Data Submissions for 2015 Benefit Year for Interim Reinsurance Payments and Interim Risk Adjustment Summary Report (PDF), Transitional Reinsurance Programs Contribution Collections for the 2015 Benefit Year (PDF), Cost-Sharing Reduction Reconciliation Guidance for Benefit Years 2014 and 2015 Final (PDF), Evaluation of EDGE Data Submissions Bulletin for the 2015 Benefit Year (PDF), Extension of Data Submission Deadline for Cost-sharing Reduction Reconciliation (PDF), Alternative Schedule for Payment of Charges for Reconciliation of the Cost-sharing Reduction Portion of Advance Payments for the 2014 and 2015 Benefit Years (PDF), Alternative Schedule for Payment of Charges for Reconciliation of the Cost-sharing Reduction Portion of Advance Payments for the 2014 and 2015 Benefit Years Issuer Agreement (PDF), Alternative Schedule for Payment of Charges for Reconciliation of the Cost-sharing Reduction Portion of Advance Payments for the 2014 and 2015 Benefit Years Extension (PDF), Netting of Payments and Charges under 45 CFR 156.1215 (PDF), Reporting Cost-sharing Reduction Amounts for 2015 MLR and Risk Corridors (PDF), Cost-Sharing Reduction Reconciliation Guidance for Benefit Year 2016 DRAFT (PDF), Risk Corridors Payments and Charge Amounts for the 2015 Benefit Year (PDF), 2016 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Evaluation of EDGE Data Submissions for 2016 Benefit Year (PDF), Final Cost-Sharing Reduction Reconciliation Guidance for Benefit Year 2016 (PDF), Transitional Reinsurance Program CMS to Begin Operating on behalf of the State of Connecticut (effective April 7, 2017) (PDF), HHS-Operated Risk Adjustment Data Validation (HHS-RADV) 2016 Benefit Year Implementation and Enforcement (PDF), CSR Reconciliation Discrepancy Inbound Specification for the 2016 Benefit Year and Prior Year Restatements (PDF), 2017 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (SASsoftware.zip) (ZIP), Creation of the 2018 Benefit Year HHS-Operated Risk Adjustment Adult Models Draft Prescription Drug (RXCUIs) to HHS Drug Classes (RXCs) Crosswalk Memorandum (PDF), 2018 Benefit Year HHS-Operated Risk Adjustment Adult Models Draft Prescription Drug (RXCUIs) to HHS Drug Classes (RXCs) Crosswalk (XLSX), Evaluation of EDGE Data Submissions for the 2017 Benefit Year (PDF), 2017 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Final Cost-Sharing Reduction Reconciliation Guidance for Benefit Year 2017 (PDF), Final Cost-Sharing Reduction Reconciliation Issuer to MIDAS Inbound Specification for the 2017 Benefit Year and 2016 Restatements (PDF), Final Cost-Sharing Reduction Reconciliation Issuer to MIDAS Attestation Inbound Specification for the 2017 Benefit Year and 2016 Restatements (PDF), Final Cost-Sharing Reduction Reconciliation Data File Error Code List for the 2017 Benefit Year and 2016 Restatements (PDF), Final Cost-Sharing Reduction Reconciliation Attestation File Error Code List for the 2017 Benefit Year and 2016 Restatements (PDF), 2018 Benefit Year Risk Adjustment SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Exemption from HHS-Operated Risk Adjustment Data Validation (HHS-RADV) for Issuers in Liquidation or Entering Liquidation (PDF), Guidance on Enrollee-level EDGE Dataset for Research Requests (PDF), CSR Reconciliation Discrepancy Inbound Specification for the 2017 Benefit Year and 2016 Prior Year Restatement (PDF), Implications of the Decision by United States District Court of the District of New Mexico on the Risk Adjustment and Related Programs (PDF), CSR Reconciliation Discrepancy FAQ Submitting New Claims for Benefit Year 2017 (PDF), Update on the HHS-operated Risk Adjustment Program for the 2017 Benefit Year (PDF), Updated 2019 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF), Updated 2019 Benefit Year Final HHS Risk Adjustment Model Coefficients (XLSX), Evaluation of EDGE Data Submissions for the 2018 Benefit Year (PDF), 2018 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Final Cost-sharing Reduction Reconciliation Issuer to MIDAS Inbound Specification for the 2018 Benefit Year and 2017 Restatements (PDF), Final Cost-Sharing Reduction Reconciliation Issuer to MIDAS Attestation Inbound Specification for the 2018 Benefit Year and 2017 Restatements (PDF), Final Cost-sharing Reduction Reconciliation Data File Error Code List for the 2018 Benefit Year and 2017 Restatements (PDF), Final Cost-Sharing Reduction Reconciliation Attestation File Error Code List for the 2018 Benefit Year and 2017 Restatements (PDF), Proposed Change to Risk Adjustment Holdback for the 2018 Benefit Year and Beyond (PDF), Proposed Updates to the 2018 Benefit Year HHS-Risk Adjustment Data Validation (HHS-RADV) Timeline (PDF), Final 2018 Benefit Year HHS- Risk Adjustment Data Validation (HHS-RADV) Timeline (PDF), Change to Risk Adjustment Holdback Policy for the 2018 Benefit Year and Beyond (PDF), Potential Updates to HHS-HCCs for the HHS-operated Risk Adjustment Program (PDF), 2019 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Evaluation of EDGE Data Submissions for the 2019 Benefit Year (PDF), 2019 HHS Risk Adjustment Data Validation (HHS-RADV) White Paper (PDF), Educational Webinar: Overview of the 2019 HHS-RADV White Paper (PDF), 2019 Benefit Year Risk Adjustment SAS Version of HHS-Development Risk Adjustment Model Algorithm Software (ZIP), Draft ICD-10 Crosswalk for Potential Updates to HHS-HCC Risk Adjustment Model for the 2021 Benefit Year (technical documentation corresponding to the HHS Notice of Benefits and Payments Parameters for 2021, Proposed Rule, and Potential Updates to HHS-HCCs for the HHS-operated Risk Adjustment Program technical paper published on June 17, 2019) (XLSX), Risk Adjustment Telehealth and Telephone Services During COVID-19 FAQs (PDF), Final 2021 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF), Revised V07 ICD-10 Crosswalk for HHS-HCC Risk Adjustment Model (XLSX), Evaluation of EDGE Data Submissions for the 2020 Benefit Year (PDF), 2020 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Final Cost-sharing Reduction Reconciliation Attestation File Error Code List for the 2020 Benefit Year and 2019 Restatements (PDF), Updated 2022 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF), 2021 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Evaluation of EDGE Data Submissions for the 2021 Benefit Year (PDF), HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes (PDF), HHS-Operated Risk Adjustment Technical Paper on Possible Model Changes: Summary Results for Transfer Simulations (PDF), Final Cost-sharing Reduction Reconciliation Issuer to MIDAS Inbound Specification for the 2021 Benefit Year and 2020 Restatements (PDF), Final Cost-sharing Reduction Reconciliation Issuer to MIDAS Attestation Inbound Specification for the 2021 and Benefit Year and 2020 Restatements (PDF), Final Cost-sharing Reduction Reconciliation Data File Error Code List for the 2021 Benefit Year and 2020 Restatements (PDF), Final Cost-sharing Reduction Reconciliation Attestation File Error Code List for the 2021 Benefit Year and 2020 Restatements (PDF), 2023 Benefit Year Final HHS Risk Adjustment Model Coefficients (PDF), 2022Benefit Year Risk Adjustment:SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), Evaluation of EDGE Data Submissions for the 2022 Benefit Year (PDF), 2022 Benefit Year Risk Adjustment: SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP), State Flexibility Requests Relating to Risk Adjustment Transfer Reductions for the 2020 Benefit Year (Document 1) (PDF), Small Group Market Request (Document 2) (PDF), State Flexibility Requests Relating to Risk Adjustment Transfer Reductions for the 2021 Benefit Year (PDF), State Flexibility Requests Relating to Risk Adjustment Transfer Reductions for the 2022 Benefit Year (PDF), State Flexibility Requests Relating to Risk Adjustment Transfer Reductions for the 2023 Benefit Year (Document 1) (PDF), State Flexibility Requests Relating to Risk Adjustment Transfer Reductions for the 2024 Benefit Year(PDF), Application, Review, and Reporting Process for Waivers for State Innovation, CMS-9987-F: Application, Review, and Reporting Process for Waivers for State Innovation, IRS Revenue Procedures Published in the Federal Register For Tax-Exempt 501(c)(29) Qualified Nonprofit Health Insurance Issuers, Questions and Answers on Consumer Operated and Oriented Plan Program Contingency Fund (PDF), CMS-4140-F: Final Rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008, Warning Signs- Plan or Policy Non-Quantitative Treatment Limitations (NQTLs) that Require Additional Analysis to Determine Mental Health Parity Compliance (PDF), Self-Compliance Tool for the Mental Health Parity and Addiction Equity Act (MHPAEA), Form to Request Documentation from an Employer-Sponsored Health Plan or and Issuer Concerning Treatment Limitations, CMS-9979-P: Incentives for Wellness Programs in Group Health Plans, CMS-9972-P:Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review, CMS-9979-F: Incentives for Nondiscriminatory Wellness Programs in Group Health Plans, CMS-9943-IFC: Third Party Payor Interim Final Rule with Comment, MS-9949-P: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond, CMS-9949-F: Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond, CMS-9932-F: Excepted Benefits; Lifetime and Annual Limits; and Short-Term, Limited-Duration Insurance, CMS-9924-P: Short-Term, Limited-Duration Insurance, CMS-9924-F: Short-Term, Limited Duration Insurance, CMS-9921-NC: Request for Information Regarding the Sale of Individual Health Insurance Coverage Across State Lines Through Health Care Choice Compacts, Employer Prescription Drug Coverage that Supplements Medicare Part D Coverage provided through an Employer Group Waiver Plan (PDF), Guidance Regarding Age Curves, Geographical Rating Areas and State Reporting (PDF), State Rating Requirements Disclosure Form (DOCX), Model Language for Individual Market Renewal Notices (PDF), Minimum Essential Coverage Guidance (PDF), Procedural Guidance Regarding State Reporting for Plan or Policy Years Beginning in 2015 (PDF), Standard Notices for Transition to ACA Compliant Policies (PDF), Questions on Transition to ACA Compliant Policies (PDF), Options Available for Consumers with Cancelled Policies (PDF), Questions and Answers on Options Available for Consumers with Cancelled Policies (PDF), Extended Transition to Affordable Care Act-Compliant Policies (PDF), Frequently Asked Question on Coverage of Same-Sex Spouses (PDF), Draft Notices When Discontinuing or Renewing a Product in the Group or Individual Market (PDF), Draft Standard Notices When Discontinuing or Renewing a Product in the Small Group or Individual Market (PDF), Instructions for Draft Standard Notices for Product Discontinuation and Renewal (PDF), Form and Manner of Notices When Discontinuing or Renewing a Product in the Group or Individual Market (PDF), Minimum Essential Coverage Application Review Process (PDF), uidance on Federal Standard Notices of Product Discontinuation and Renewal in Connection with the Open Enrollment Period for the 2016 Coverage Year (PDF), Extension of Transitional Policy through Calendar Year 2017 (PDF), Draft Updated Federal Standard Renewal and Product Discontinuation Notices (PDF), Final Updated Federal Standard Renewal and Product Discontinuation Notices (PDF), Extension of Transitional Policy through Calendar Year 2018 (PDF), Enforcement Safe Harbor for Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the 2018 Benefit Year Individual Market (PDF), Enforcement Safe Harbor for Renewal Notices in Connection with the Open Enrollment Period for Non-Grandfathered Coverage in the 2018 Individual Market Benefit Year (PDF), Extension of Transitional Policy through Calendar Year 2019 (PDF), Updated Federal Standard Renewal and Product Discontinuation Notices (PDF), Enforcement Safe Harbor for Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the 2019 Benefit Year Individual Market (PDF), Guidance Regarding Offering of Plans that are not QHPs without CSR Loading (PDF), Extension of Limited Non-Enforcement Policy through Calendar Year 2020 (PDF), Updated Federal Standard Renewal and Product Discontinuation Notices, and Enforcement Safe Harbor for Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the Individual Market in the 2020 Benefit Year (PDF), Updated Federal Standard Renewal and Product Discontinuation Notices in the Individual Market (Required for Notices Provided in Connection with Coverage Beginning in the 2021 Plan Year) (PDF), Opportunity for States to Participate in a Wellness Program Demonstration Project to Implement Health-Contingent Wellness Programs in the Individual Market (PDF), Extension of Limited-Non-Enforcement Policy through Calendar Year 2021 (PDF), Procedural Guidance for States to Recommend Restricting Certain Excepted Benefit Health Reimbursement Arrangements from Reimbursing Premiums for Short-term, Limited-duration Insurance (PDF), Extension of Limited Non-Enforcement Policy through Calendar Year 2022 (PDF), Enforcement Safe Harbor for individual Market Product Discontinuation Notices in Connection with the Open Enrollment Period for Coverage in the 2022 Benefit Year (PDF), Extension of Limited Non-Enforcement Policy through Calendar Year 2023 and Later Benefit Years (PDF), Enforcement Safe Harbors related to Federal Standard Renewal and Product Discontinuation Notices; 90-Day Product Discontinuation Notice Requirement in the Individual Market (PDF).