Regulatory Joe

The ACA marketplace is heading into one of its most uncertain years yet.

In this episode, Joe Boyle is joined by Jeff Grant—former Deputy Director of Operations at CCIIO and now president of Schedule F Consulting—to unpack what 2026 could bring for health plans.

They explore the potential expiration of enhanced premium tax credits (APTCs), the debate over re-funding cost-sharing reductions (CSRs), and how these shifts could reshape affordability, enrollment behavior, and silver loading strategies.

Plus: insights on rate setting amid uncertainty, the evolving role of ICHRAs, and what plans should be doing now to prepare for every scenario.

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 accuracy. Bryan shares what tripped up issuers last year, what tools are critical for success, and how internal misalignment (especially with PBMs and pharmacy teams) can derail your entire submission.

In this episode:

The top objection trends from Plan Year 2025

How to use CMS validation tools to avoid rework

Why cross-validation errors can still cost you—even if your template looks “clean”

What to expect from CMS as MPMS continues to evolve

Practical tips for internal coordination and compliance

Whether you're a seasoned filer or new to regulatory operations, this episode offers actionable insight to help you stay compliant, avoid objections, and file with confidence.

🎧 Listen now and future-proof your pharmacy benefit template strategy.

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 compliance teams looking to streamline filings and reduce last-minute surprises.

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:

#CMSRegulations #HealthPlans #MPMS #PlanSubmission #HealthcareCompliance

🚨 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 to strategize—but also more details to analyze.

Key Topics Covered:

🔗 For more insights, visit: regulatoryjoe.co

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:

Whether you’re an established issuer or entering a new market, this episode is packed with actionable insights and practical recommendations to help you stay compliant, optimize processes, and prepare for the future of risk adjustment.

🎧 Listen now and make sure your team is ready for the 2025 submission season. Subscribe to Regulatory Joe for updates on regulatory filing for health plans, compliance tips, and more.

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 standalone state-based marketplaces, the role of enhanced direct enrollment in maintaining a seamless member experience, and how carriers can align strategies to navigate these changes.

Whether you're preparing for an SBM transition or want to better understand these hybrid models, this episode provides valuable insights for health plan professionals.

Listen now to stay informed, and don’t forget to like, share, and subscribe!

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:

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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

🔔 Subscribe for more regulatory insights and health plan updates!

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

🔔 Subscribe for more regulatory insights and health plan updates!