Published Guidance & Regulations

Below are short descriptions and links to published guidance documents and regulations related to QHP certification.

CMS Letter to Issuers

The CMS Letter to Issuers in the Federally-facilitated Exchanges provides guidance for issuers seeking to offer QHPs, including stand-alone dental plans (SADPs) in the Federally-facilitated Exchanges (FFEs) or Federally-facilitated Small Business Health Options Program (FF-SHOP) Exchanges. 

Notice of Benefit and Payment Parameters 

An annual Notice of Benefit and Payment Parameters (Payment Notice) sets payment parameters and new standards to improve consumers’ Exchange experience. For 2022, CMS is finalizing the payment notice in multiple phases. The first 2022 Payment Notice final rule displayed in the Federal Register on January 19, 2021. The second 2022 Payment Notice final rule was released May 5, 2021, and continues CMS’s trend toward stabilizing the insurance market, promoting program integrity, and reducing regulatory burden. The third 2022 Payment Notice final rule was published in the Federal Register on September 27, 2021. Issuers are responsible to ensure compliance with CMS regulations and guidance. The final rules are provided below.

QHP Data Submission and Certification Timeline Bulletin

The QHP Data Submission and Certification Timeline bulletin contains guidance for purposes of establishing the submission deadlines under 45 CFR 155 subpart K for health insurance issuers applying to offer QHPs on the FFEs, including the timeline for QHP certification. New for PY2022, CMS is publishing this timeline separately from the annual Letter to Issuers in the FFEs. 

Final Rule for Exchange and Insurance Market Standards

The Final Rule for Exchange and Insurance Market Standards finalizes the policies and standards regarding consumer notices, the quality report and enrollee satisfaction survey, the SHOP Market, navigators and other consumer assisters, and the premium stabilization programs.

Health Insurance Market Reforms

Health Insurance Market Reforms provides general CMS guidance. 

Health Insurance Marketplaces

Health Insurance Marketplaces provides general CMS guidance.  

SADP Voluntary Reporting Guidance

CMS is releasing this summary of the results of the voluntary reporting information reported by issuers that intend to offer Exchange-certified stand-alone dental plans (SADPs) for plan year 2022 through the Exchange in states with Federally-facilitated Exchanges (FFEs), including states performing plan management functions. The documents below reflect the survey results, the survey instrument, and a letter that provides information to SADPs on the purpose of this data collection and how to submit the survey that was due on February 15, 2021, as well as frequently asked questions.

HICS Access Guidance

QHP issuers operating in FFEs or in states that delegate certain authorities to the FFE resolve consumer cases through the Health Insurance Casework System (HICS). The document below provides information to issuers about how to request access to HICS.