QHP Marketplace Resources

Stay up-to-date on the latest network adequacy requirements and best practices for Qualified Health Plans (QHPs). Explore our growing library of blogs, briefs, videos and more!

New! Legislative Brief

New QHP Certification Requirements

On April 28, 2022, the Department of Health and Human Services (HHS) released the Notice of Benefit and Payment Parameters (NBPP) for 2023 Final Rule. In addition, the Centers for Medicare & Medicaid Services (CMS) issued the 2023 Final Letter to Issuers in the Federally-facilitated Exchanges (also known as the 2023 Final Letter).

The NBPP and 2023 Final Letter included significant changes to network adequacy reviews of health plans and stand-alone dental plans (SADPs) applying to offer qualified health plans (QHPs) through Federally-facilitated Exchanges (FFEs) and State-based Exchanges on the Federal platform (SBE-FPs). In this brief, we discuss the new network adequacy standards and requirements for the 2023 plan year (PY 2023) and changes coming in the 2024 plan year (PY 2024).

NBPP for 2023 QHP Certification Network Adequacy Requirements
New! Overview

Overview: New QHP Certification Requirements

The Centers for Medicare & Medicaid Services (CMS) will evaluate the adequacy of provider networks of Qualified Health Plans (QHPs) offered through the Federally-facilitated Exchanges (FFEs), or of plans seeking certification as FFE QHPs, except for FFEs in certain States beginning with the QHP certification cycle for PY 2023.

Federally-facilitated marketplace changes coming to the networks adequacy review timeline preview.
Updated March 30, 2022:

QHP Data Submission and Certification Calendar

This snazzy timeline highlights the major milestones for issuers offering a Qualified Health Plan (QHP) in a Federal Exchange state. Best yet, we’ll keep it updated as time goes on so you can stay on top of your game. Go ahead and download it, save it as your background, print it – or share it with a colleague.

Regulatory Review:

Rewriting the Rules for Qualified Health Plans on the Federally-facilitated Exchange

Qualified Health Plans (QHPs) offered through the Federally-facilitated Exchange (FFE) are waiting for final details about their new network adequacy standards and requirements. Although the final details are being developed, we’ve received a few clues about what they may look like. In this episode, Scott Westover, SVP of Network and Regulatory Strategy, Quest Analytics, explores what issuers can expect and provides an overview of the anticipated timeline for implementation.

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Articles

Article:

Overview of the Proposed Notice of Benefit and Payment Parameters for 2023 Rule

The Centers for Medicare & Medicaid Services (CMS) issued its proposed version of the Notice of Benefit and Payment Parameters (NBPP) for 2023 rule. This article give you a comprehensive overview of the proposed changes.

Article:
New Approach to Network Adequacy
Article:
CMS to Regulate Qualified Health Plan (QHP) Network Adequacy
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Legislative Briefs

Federal court vacates 2019 rule on federal review of network adequacy legal brief downloadable.

Legislative Brief

Court Vacates 2019 Payment Notice on Federal Review of Network Adequacy

Changes coming to network adequacy reviews legal brief downloadable.

Legislative Brief

HHS Notice of Benefit and Payment Parameters for 2022 Second Final Rule

Complimentary Strategy Session

Compliance isn’t our name, but it sure is our game! Learn how we can assist your efforts to make your provider data accurate and network adequate. Book a complimentary strategy session with a Quest Analytics expert to get started on your quest for success.

Book a Strategy Session

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