Description
Stay ahead of regulatory changes impacting Exchanges, Qualified Health Plans (QHPs), and health insurance issuers with this in-depth course based on the 2027 HHS Notice of Benefit and Payment Parameters Final Rule. Learn how new payment parameters, risk adjustment (HHS-RADV), user fee rates, expanded hardship exemptions, SEIPM implementation, and civil money penalty updates affect compliance, certification, plan design, provider access, and reporting. Get actionable strategies to ensure your organization remains compliant and ready for audits while safeguarding program integrity.
In this course you will learn the following:
* Describe the statutory and regulatory framework for 45 CFR Parts 150, 155, and 156.
* Identify and define key terms and entities subject to the Final Rule.
* Explain the requirements for Exchange operations, QHP certification, and plan design.
* Apply eligibility, enrollment, and exemption standards in compliance with the rule.
* Implement provider access and ECP standards for network adequacy.
* Maintain program integrity through proper data submission, sampling, and error resolution.
* Develop and execute corrective action plans in response to compliance failures.
* Adhere to cost-sharing, catastrophic plan, and actuarial value requirements.
* Fulfill agent, broker, and web-broker registration, training, and conduct standards.
* Comply with user fee, risk adjustment, and financial management obligations.
* Respond to enforcement actions, penalties, and appeals processes.
* Meet administrative and reporting requirements efficiently.
* Utilize actionable steps and best practices for successful implementation and ongoing compliance.
* Recognize the consequences of non-compliance and the importance of maintaining program integrity.
