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    • HEALTH CARE REFORM—D.D.C.: QHP certification denial not arbitrary and capricious where applicant demonstrated pattern of missteps
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    Health Law Daily Wrap Up, REGULATION TRACKER—Information on pending or recently adopted regulations and regulation amendments, (Oct 15, 2024)

    By WK Editorial Staff

    This Health Law Regulation Tracker includes a Proposed Rules Comment Calendar and a Table of Final Rule Effective Dates.

    New proposed rules. On October 10, 2024, CMS proposed to include payment parameters and provisions related to the HHS-operated ris ...

    By WK Editorial Staff

    This Health Law Regulation Tracker includes a Proposed Rules Comment Calendar and a Table of Final Rule Effective Dates.

    New proposed rules. On October 10, 2024, CMS proposed to include payment parameters and provisions related to the HHS-operated risk adjustment and risk adjustment data validation (HHS–RADV) programs, as well as 2026 benefit year user fee rates for issuers that participate in the HHS-operated risk adjustment program and the 2026 benefit year user fee rates for issuers offering qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE–FPs). The proposed rule also includes proposed requirements related to modifications to the calculation of the Basic Health Program (BHP) payment; and changes to the Initial Validation Audit (IVA) sampling approach and Second Validation Audit (SVA) pairwise means test for HHS–RADV. It also addresses HHS’ authority to engage in compliance reviews of and take enforcement action against lead agents of insurance agencies for violations of HHS’ Exchange standards and requirements; HHS’ system suspension authority to address noncompliance by agents and brokers; an optional fixed-dollar premium payment threshold; proposed reconsideration standards for certification denials; proposed changes to the approach for conducting Essential Community Provider (ECP) certification reviews; a proposal to publicly share aggregated, summary-level Quality Improvement Strategy (QIS) information on an annual basis; and proposed revisions to the medical loss ratio (MLR) reporting and rebate requirements for qualifying issuers that meet certain standards.

    See the Regulation Tracker for details.

    New final rules. No new final rules have been issued since October 7, 2024.

    See the Regulation Tracker for details.

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