News: 2022 Notice of Benefit and Payment Parameters provides insight to risk adjustment changes

CMS released the second 2022 Notice of Benefit and Payment Parameters final rule (second notice), including information on risk adjustment changes for the Affordable Care Act (ACA) marketplace.

The Department of Health & Human Services (HHS) said it has not finalized many of the proposed updates included in the 2022 payment notice proposed rule. Proposed changes include a two-step specification in the adult and child models. The first step proposed is to replace the existing severity of illness indicators in the adult models with new hierarchical condition category severity indicator counts in the adult and child models. The second step is to modify the enrollment duration factors in the adult model.

Instead of finalizing this two-step change, CMS said it will release a document in the future with more data on the impact of the proposed model specification changes. Until then, the risk adjustment model specifications finalized on the 2021 payment notice will continue to apply for the 2022 benefit year.

In addition, the second notice aims to stabilize the ACA marketplace by lowering maximum consumer out-of-pocket costs by $400, promoting program integrity, and reducing regulatory burden.

Editor’s note: The second 2022 Notice of Benefit and Payment Parameters final rule can be found here.