CMS Issues 2026 Notice of Benefit and Payment Parameters Proposed Rule

The Centers for Medicare & Medicaid Services (CMS) on Oct. 4 issued the Notice of Benefit and Payment Parameters proposed rule for 2026, which establishes parameters for issuers offering qualified health plans (QHPs) through federally facilitated Marketplace (FFEs) and state-based Exchanges on the federal platform (SBE-FPs). Exchanges are entities, established under the Patient Protection and Affordable Care Act (PDF, P.L. 111-148), through which qualified individuals and qualified employers can purchase health insurance coverage in QHPs.

Highlights of the proposed rule include:

• Strengthening review and enforcement of unscrupulous broker and agent practices.
• Refining the risk adjustment program to phase out a market pricing adjustment for hepatitis C drugs and to include an HIV PrEP-affiliated cost factor.
• Increasing user fees in anticipation of the expiration of enhanced premium subsidies under the Inflation Reduction Act (PDF, P.L. 117-169).
• Seeking comment on whether to codify the practice of "silver loading," whereby QHPs increase premiums to cover the expense of cost-sharing reductions required by statute.
• Improving transparency and public reporting of data on SBEs and SBE-FPs.

The CMS will accept comments until Nov. 12.