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. On April 28, 2022, CMS released the Final 2023 Letter to Issuers in the Federally-facilitated 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. CMS released the HHS Notice of Benefit and Payment Parameters Final Rule for 2023 on April 28, 2022. Issuers are responsible to ensure compliance with CMS regulations and guidance.

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. As in 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.  

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.