HHS Notice of Benefit and Payment Parameters for 2023
Final rule setting payment parameters, risk adjustment and RADV program changes, user fees, Exchange standards, and other ACA-related market standards for qualified health plans offered through Federally-facilitated and certain State-based Exchanges; affects QHP issuers, Exchanges, States, and related stakeholders.
Removal of severity illness factors from adult risk adjustment models and addition of an interacted HCC count model specification for adult and child models beginning with the 2023 benefit year.
Replacement of current enrollment duration factors in adult models with HCC-contingent enrollment duration factors for 2023.
Finalized refinements to HHS-RADV error estimation methodology beginning with the 2021 benefit year, including broader application of Super HCCs.
New display and conduct requirements for agents, brokers, and web-brokers and new web-broker non-Exchange website display rules.
Codified MLR policy limiting inclusion of provider incentives/bonuses and QIA expenses to those tied to measurable clinical or quality improvement activities.
Appointment wait time standards will be implemented beginning in PY 2024.
ECP certification threshold increased from 20 percent to 35 percent.
QHP issuers remain responsible for downstream and delegated entities' adherence to Federal standards with explicit oversight obligations.
Requirement for issuers to submit information about whether providers offer telehealth services.
Quality improvement strategy (QIS) standards updated to require addressing health and health care disparities beginning in 2023.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.