Rule summary:
Amended 2022 Standard Bronze and Silver Plans. Refiling to include the 2022 Standard Bronze and Silver Plan attachment within the rule text.
Rules affected: OAR 836-053-0013
Need for Rules:
ORS 743B.130 requires the Department of Consumer and Business Services (DCBS) to prescribe by rule the form, level of coverage, and benefit design for bronze and silver health benefit plans that must be offered by insurance carriers. These plans must meet federal requirements issued by the Department of Health and Human Services (HHS). Each year, HHS updates the actuarial value (AV) calculator used for determining coverage levels. Changes may include costs, plan designs, populations, developments in the function and operation of the AV calculator and other actuarially relevant factors. DCBS provides exhibits to the standard bronze and silver plans, in rule, that prescribe the benefits the plans must provide.
As a result of the passage of Oregon House Bill 2623, DCBS was required to amend the exhibits to the standard bronze and silver plans in order to comply with both federal and state law. HB 2623 limits the cost-sharing for health benefit plan coverage of insulin prescribed for treatment of diabetes. As a result, the AV for the standard plans was too high, requiring DCBS to lower certain other benefits to come into compliance with HHS requirements.
In a previous rulemaking for OAR 836-053-0017, effective 1/1/2021, DCBS made changes to essential health benefits (EHBs), reflecting changes to chiropractic and acupuncture care, which were approved by the Centers for Medicare and Medicaid Services (CMS). The standard plan exhibits were updated to accurately reflect these previously approved and already covered benefits.
Filed: August 30, 2021
Public hearing: September 22, 2021, 11:00 a.m.
Last day for public comment: September 29, 2021, 5 p.m.
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