Regulatory Joe

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 submission rework

This episode is a must-listen for issuers and com...

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 new timing challenges.

In this episode, we break down:

• How the new MPMS Justifica...

🚨 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 moving up the timeline for finalizing regulations, issuers have more time than ever...

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 in shaping membership trends and user fees
• Key strategies for issuers entering n...

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 operational implications for health plans. Joe also explains the transition process to standalo...

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 practices for mapping and validation
• Tips for ensuring data accuracy and avoiding com...

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
• Best practices for version control and documentation when running the AV calculato...

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 results could reshape federal and state control over ACA marketplaces
• The futur...

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 experience across Healthcare.gov and state exchanges
• Simplified plan selection t...

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 drug coverage updates New re-enrollment hierarchy rules Stricter network adequacy...