On this episode of Regulatory Joe, Joe Boyle is joined by Penstock’s Director of Plan Management, Bryan Connole, to dive into one of the biggest pain points in ACA regulatory filing: the pharmacy benefit template. As Plan Year 2026 approaches, CMS and state agencies are tightening expectations—especially around prior authorization and template accu…

In this episode, Regulatory Joe walks through the critical roles of reconciliation and validation in preparing ACA plans for the 2026 plan year. Joe covers: How to balance required CMS changes with strategic updates What’s new in MPMS and CMS templates Why treating draft templates as final saves time Tips to align cross-functional teams and avoid s…

A major change is coming for health plan issuers—CMS is restructuring how Plan and Benefit Justification Forms are handled. Starting in 2026, issuers will no longer upload Justification Forms alongside their Plan and Benefit Templates. Instead, CMS will generate them post-submission through the MPMS portal, limiting issuer control and introducing n…

🚨 The 2026 Notice of Benefit and Payment Parameters (NBPP) is here! What does it mean for health plans? In this episode of Regulatory Joe, we break down the latest ACA compliance updates for 2026, including key changes in AV calculations, special enrollment periods, state-based marketplace transitions, and income verification requirements. With CMS…

Join Joe Boyle, President of Regulatory Solutions at Penstock, as he breaks down CMS’s risk adjustment and user fee updates for benefit year 2025. This episode is your go-to guide for navigating the evolving regulatory landscape. Here’s What You’ll Learn: How CMS’s use of 2019–2021 data impacts 2025 submissions The role of the American Rescue Plan …

SBM-FPs Explained: What Health Plans Need to Know What are state-based marketplaces operating on the federal platform (SBM-FPs), and why are they becoming a popular choice for states? In this episode, Joe Boyle breaks it all down. Learn the fundamentals of SBM-FPs, including how they operate, why states choose them, and the financial and operationa…

In today’s episode of Regulatory Joe, we’re diving into the 2025 Rates and Benefits Information System (RBIS) updates, highlighting what health plans need to know to ensure accurate and compliant submissions. 📌 Key Takeaways: The new four-window CMS schedule and how to stay ahead of critical deadlines Updated URL submission criteria and best practi…

In today’s episode of Regulatory Joe, we’re taking listeners through the 2025 Actuarial Value (AV) calculator, a tool that ensures plans meet standards for each metallic tier. 📌 Key Takeaways: Consistent AV ranges for 2025 across all metallic tiers, with no major changes Early testing with the draft AV calculator to stay on track with compliance Be…

In this episode of Regulatory Joe, we break down the critical changes to Healthcare.gov that will reshape health plans in 2025. From streamlined enrollment to simplified plan selection, we dive into how these updates will impact issuers and plan operations in both federally facilitated and state-based marketplaces. 📌 Key Takeaways: How the election…

In this episode of Regulatory Joe, we break down the critical changes to Healthcare.gov that will reshape health plans in 2025. From streamlined enrollment to simplified plan selection, we dive into how these updates will impact issuers and plan operations in both federally facilitated and state-based marketplaces. 📌 Key Takeaways: Consistent user …

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In this episode of Regulatory Joe, we cover the critical changes coming in 2025 for the Notice of Benefit and Payment Parameters (NBPP). Learn how telehealth, prescription drug access, re-enrollment rules, and network adequacy standards will shape health plans next year. 📌 Key Takeaways: Expanded telehealth documentation requirements Prescription d…

In today’s episode of Regulatory Joe, we’re diving into an important topic that is shaping the future of health plan offerings: Essential Health Benefit (EHB) benchmark updates. Don't miss an episode! Hit subscribe or get email notifications by signing up at regulatoryjoe.co today.By Penstock

In today's episode of Regulatory Joe, we cover a timely and impactful topic: the consideration of routine adult dental as an Essential Health Benefit (EHB) starting in 2025. This policy change by CMS poses significant implications for health plans and their members—let’s explore what this means and how health plans can prepare. 💡 Check out all of o…

In today’s episode of Regulatory Joe, we’re discussing standard/non-standard plan options and potential changes on the horizon for 2025 and beyond. Don't miss an episode! Hit subscribe or get email notifications by signing up at regulatoryjoe.co today.By Penstock

In today’s episode of Regulatory Joe, we’re diving into the important topic of network adequacy and significant changes that health plans need to be aware of for 2025 and beyond. Don't miss an episode! Hit subscribe or get email notifications by signing up at regulatoryjoe.co today.By Penstock

In today’s episode of Regulatory Joe, we’re discussing state-mandated benefit defrayal and potential changes on the horizon for 2025 and beyond. Don't miss an episode! Hit subscribe or get email notifications by signing up at regulatoryjoe.co today.By Penstock

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