Skip to main content

Analysis

CMS Issues 2021 Payment Notice

By Jack O'Brien  
   May 07, 2020

The final payment notice also maintains lower fee rates for issuers participating in the exchange platform created by last year's payment notice.

The Centers for Medicare & Medicaid Services (CMS) released the final payment notice for the 2021 coverage year Thursday afternoon.

Under the 2021 payment notice, issuers can offer "high-value services" to patients with "zero cost sharing," according to a CMS press release. Additionally, individual market issuers may offer "wellness incentives" to consumers by recognizing incentives like quality improvement activities.

The final payment notice also maintains lower fee rates for issuers participating in the exchange platform created by last year's payment notice.

Related: Site-Neutral Back Pay: CMS to Give Hospitals More Money for 2019, Carry Fight Into 2020

"When the Trump Administration took office, the individual market was in crisis," CMS Administrator Seema Verma, said in a statement. "Premiums had doubled and even tripled in some states, and choices had plummeted as issuers fled the market. Our policies delivered a sorely needed course correction, prioritizing competition and flexibility over prescriptiveness. The result was lower premiums and more options. Today’s rule delivers more of the same, and American consumers will continue to reap the benefits."

CMS stated that consumers will be able to make coverage changes sooner under special enrollment periods starting in 2022. The payment notice will also expand flexibility options for state-based exchanges that "operate their own eligibility and enrollment platforms," according to the agency.

Related: CMS Finalizes 2019 Inpatient Payment Rules

The payment notice finalized enhancements to the Periodic Data Matching in an effort to reduce Advance Payments of the Premium Tax Credit payments incorrectly sent to "enrollees determined to be deceased or dually enrolled in Medicare."

Another requirement included in the notice is that states must notify CMS every year regarding any additional state-required benefit mandates.

In addition to releasing the 2021 final payment notice, CMS extended the Qualified Health Plan (QHP) certification and rate review timelines by one week due to the ongoing coronavirus disease 2019 (COVID-19) outbreak.

Related: COVID-19 Strikes Interoperability Rules

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


Get the latest on healthcare leadership in your inbox.