February 05, 2020
In the 2021 Notice of Benefit and Payment Parameters, the Centers for Medicare and Medicaid Services (CMS) outlines a value-based insurance design (VBID) for qualified health plans (QHPs) to incorporate into plans offered on the federal exchange.
The agency details options for QHPs to provide higher value services at lower costs to patients. Plans could incentivize consumers to access higher value services and drugs by offering them at lower or zero cost sharing while setting higher consumer cost sharing for low value services and drugs. This framework is based upon shifting cost-sharing from higher cost to lower cost services. Plans would have the flexibility to implement any or all of the proposed VBID components. The agency indicates that plans implementing value-based design components wouldn’t have a more favorable placement on healthcare.gov.
The agency is requesting feedback from stakeholders to incorporate other VBID components into the proposed framework. Additional information can be found on this proposed rule fact sheet.