SECTION 3. GUIDANCE

The percentage increase in the CPI-U over a preceding year is calculated by dividing the average CPI-U for the preceding year by the average CPI-U for the year immediately prior to the preceding

year. For this purpose, the average CPI-U for a year is the average of the monthly CPI-Us published by the Bureau of Labor Statistics of the Department of Labor for the 12-month period ending on August 31 of each year, rounded to 10 decimal places. The percentage increase in the CPI-U for items and services provided in 2024 over the preceding year is the average CPI-U for 2023 over the average CPI-U for 2022. Pursuant to this calculation, the percentage increase from 2023 to 2024 is 1.0543149339. Further, pursuant to this notice, plans and issuers may round any resulting QPAs to the nearest dollar.

To calculate the adjusted QPA, the prior year’s adjusted QPA is multiplied by the percentage increase for the most recent year. To simplify this calculation, this notice provides cumulative percentage increases. To calculate the adjusted QPA for items and services furnished in 2024, the “base year” QPA is multiplied by the cumulative percentage increase for the year the base QPA originated. A plan or issuer may select their preferred method, but it must be applied consistently. A plan or issuer is not permitted to use one method for certain QPAs and a different method for other QPAs.

.01 Adjusting QPAs based on January 31, 2019 rates. For QPAs calculated by increasing the median contracted rate for 2019, the QPAs for items and services furnished in 2024 are determined by taking the QPAs calculated for items and services furnished in 2023 and multiplying the 2023 adjusted QPAs by the percentage increase from 2023 to

2024 (1.0543149339). Alternatively, the QPAs for items and services furnished in 2024 may be calculated by increasing the median contracted rate for 2019 by the 2024 cumulative percentage increase for the 2019 base year (1.2089777165).

For example, using the alternative method: An item is furnished in 2024. The median contracted rate for the item on Jan

uary 31, 2019, was $1,500. The 2024 adjusted QPA for the item can be calculated by multiplying $1,500 x 1.2089777165, resulting in $1,813. ⁷

.02 Adjusting QPAs based on 2021 rates.

For items and services furnished in 2022 for which the QPAs were calculated by increasing the median of the in-net

7 The 2022 adjusted QPA for the $1,500 item was $1,597 ($1,500 x 1.0648523983). The 2023 adjusted QPA for the item was $1,720 ($1,597 x 1.0768582128). The 2024 adjusted QPA for the item is $1,813 ($1,720 x 1.0543149339).

Bulletin No. 2024–2 315 January 8, 2024

work allowed amounts for the same or similar item or service provided in the geographic region in 2021, drawn from any eligible database, by the percentage increase from 2021 to 2022, the QPAs for items and services furnished in 2024 are determined by taking the QPAs calculated for the items and services furnished in 2022 and multiplying the 2022 adjusted QPAs by the percentage increase from 2022 to 2023 (1.0768582128) and multiplying the resulting 2023 adjusted QPAs by the percentage increase from 2023 to 2024 (1.0543149339). Alternatively, the QPAs for items and services furnished in 2024 may be calculated by multiplying the 2022 adjusted QPA by the 2024 cumulative percentage increase for the 2021 base year (1.1693822450).

For example, using the alternative method: A newly covered service for which the plan or issuer does not have sufficient information to calculate the median of the contracted rates is furnished in 2022. The median of the in-network allowed amounts for the same or similar service provided in the geographic region in 2021, drawn from any eligible database, was $4,000. The 2024 adjusted QPA for the covered service is $4,678 ($4,000 x 1.1693822450). ⁸

.03 Adjusting QPAs based on 2022 rates.

For items and services furnished in 2023 for which the QPAs were calculated by increasing the median of the in-network allowed amounts for the same or similar item or service provided in the geographic region in 2022, drawn from any eligible database, by the percentage increase from 2022 to 2023, the QPAs for items and services furnished in 2024 are determined by taking the QPAs calculated for the items and services furnished in 2023 and multiplying the 2023 adjusted QPAs by the percentage increase from 2023 to 2024 (1.0543149339). Alternatively, the QPAs for items and services furnished in 2024 may be calculated by increasing the median contracted rate for 2022 by the 2024 cumulative percentage increase for the 2022 base year (1.1353476955).

For example, using the alternative method: A newly covered service for which the plan or issuer does not have sufficient information to calculate the median of the contracted rates is furnished in 2023. The median of the in-network allowed amounts for the same or similar service provided in the geographic region in 2022, drawn from an eligible database, was $2,100. The 2024 adjusted QPA for the covered service is $2,384 ($2,100 x 1.1353476955). ⁹

The adjustment to the QPAs will be applied similarly for items and services covered by a new plan or new group or individual health insurance coverage that was not offered in a geographic region in a prior year. For items and services first offered by a new plan or new group or individual health insurance coverage in a geographic region in 2023 for which the plan or issuer does not have sufficient information to calculate the median of the contracted rates for the items or services provided in the geographic region, the QPAs are calculated by increasing the median of the in-network allowed amounts for the same or similar item or service provided in the geographic region in 2022, drawn from any eligible database, by the percentage increase from 2022 to 2023 (1.0768582128). For that plan or coverage, the QPAs for items and services furnished in 2024 are determined by taking the QPAs calculated for items and services furnished in 2023 and multiplying the 2023 adjusted QPAs by the percentage increase from 2023 to 2024 (1.0543149339).

.04 Calculating QPAs when 2024 is the first coverage year.

For newly covered items and services furnished in 2024 for which the plan or issuer does not have sufficient information, when 2024 is the first coverage year for the item or service with respect to the plan or coverage, the QPAs for the items and services first furnished in 2024 are determined by multiplying the median of the in-network allowed amounts for the same or similar item or service provided in the geographic region in 2023,

drawn from any eligible database, by the percentage increase from 2023 to 2024 (1.0543149339).

For example, using the alternative method: A newly covered service is furnished in 2024. The median of the in-network allowed amounts for the same or similar service provided in the geographic region in 2023, drawn from an eligible database, was $3,000. The 2024 adjusted QPA for the service is $3,163 ($3,000 x 1.0543149339).