A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Administration releases a deluge of ACA rules

Posted on March 17, 2014 | Comments Off

The administration recently issued several rules and guidance concerning the implementation of the Affordable Care Act (ACA). Below are key points from some of these new releases:

  • A new Frequently Asked Question (FAQ) document from the Centers for Medicare and Medicaid Services (CMS) states that most insurance plans will be required provide the same benefits to married gay couples as they do to heterosexual married couples. Insurance companies will extend these nondiscrimination policies to same sex couples for plans offered on the ACA marketplaces.
  • An interim final rule released by CMS requires plans offered through the ACA marketplaces to accept premium and cost-sharing payments from certain federal government programs. Such programs include the Ryan White HIV/AIDS program and various Indian organizations.
  • CMS also released the proposed rule concerning market standards for 2015. The rule covers a multitude of topics, ranging from new standards for self-funded non-federal plans opting out of certain Public Health Service Act (PHSA) requirements to amending guaranteed renewability stipulations.
    • One particular provision of this rule was designed to preempt state laws created to increase the certification requirements and restrict the roles of navigators and other assistors under the ACA. Additionally, the rule prohibits assistors from performing certain activities that received substantial criticism, such as cold calling potential consumers or offering cash incentives to promote enrollment. The rule also provides some leeway for insurers under the medical loss ratio (MLR) requirements as a result of the stymied roll out of the federal health insurance marketplace.
    • Another interesting provision in the rule will require insurers to provider a more robust network of doctors and hospitals for consumers. Many plans offer “narrow networks” as a mechanism to cut costs for consumers, yet many consumers are losing coverage for their family practitioners. CMS will determine whether or not the plans provide “reasonable access” to certain services, such as mental health, oncology, and primary care.
    • In addition to the rule, CMS also provided guidance regarding discontinuing or renewing policies in the group or individual markets.

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CMS releases 2015 final letter to issuer

Posted on March 14, 2014 | Comments Off

Today, the Centers for Medicare and Medicaid Services (CMS) released the finalized version of the 2015 Letter to Issuers in the Federally-facilitated Marketplaces. The letter provides technical and operational guidance to help qualified health plans (QHP) and stand-alone dental plans successfully participate in the Affordable Care Act (ACA) Marketplaces operated by the federal government.

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CCIIO issues Marketplace Blueprint

Posted on March 14, 2014 | Comments Off

The Center for Consumer Information and Insurance Oversight (CCIIO) issued their Blueprint for Approval of Affordable Health Insurance Marketplaces. This document outlines key steps for states interested in altering their Marketplace configuration for 2015. The blueprint requires states to provide a letter of intent to CCIIO by May 1st and to submit their own Marketplace blueprints by June 1st. The blueprint also reminds states that Marketplace establishment grants will still be available to them through 2015.

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CBO estimate indicates impact of repealing the individual mandate

Posted on March 13, 2014 | Comments Off

The Congressional Budget Office (CBO) score of HR 4015 found that repealing the Affordable Care Act’s (ACA) individual mandate would save the government $169.5 billion over the next 10 years. Doing so would also result in 13 million fewer individuals having insurance by 2018, and those with insurance would pay more for their coverage. Lifting the individual mandate is the current pay-for for the House bill to reform the Sustainable Growth Rate (SGR). The savings from removing the mandate would arise from the decreased issuance of health insurance subsidies, or premium tax credits.

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Georgetown and RWJF publish new navigator resource guide

Posted on March 12, 2014 | Comments Off

Georgetown University’s Center on Health Insurance Reform, in conjunction with the Robert Wood Johnson Foundation, released a navigator resource guide for the Affordable Care Act (ACA). The guide serves as a primer for health insurance reform and is intended to supplement official training documents released by the administration. Topics addressed in the guide include: health insurance marketplaces, benefit standards, cost standards, rating, and premium tax credits.

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Implementation Brief Update: Basic Health Program Final Regulations

Posted on March 12, 2014 | Comments Off

On March 7, 2014, the Centers for Medicare and Medicaid Services (CMS) published final regulations implementing the Affordable Care Act’s Basic Health Program (BHP) market option (PPACA §1331). On that date, CMS also published rules that set forth the BHP payment methodology and the data it will use to determine payments to states that establish certified BHP programs.

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CMS releases BHP final rule

Posted on March 7, 2014 | Comments Off

The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.

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Implementation Brief CMS Bulletin on Retroactive Advance Payments of Premium Tax Credits and Cost Sharing Reductions in 2014 Due to Exceptional Circumstances

Posted on March 7, 2014 | Comments Off

On February 27, 2014, CMS issued a Bulletin to Marketplaces on Availability of Retroactive Advance Payments of the PTC and CSRs in 2014 Due to Exceptional Circumstances. Using its authority to establish special enrollment periods under the ACA, CMS created a mechanism for recognizing certain “exceptional circumstances” that arise when as a result of “technical issues in establishing automated eligibility and enrollment functionality,” Exchanges have experienced difficulties in making timely eligibility determinations and enrolling people during the initial open enrollment period.

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IRS issues new ACA-related rules

Posted on March 6, 2014 | Comments Off

A final rule released by the Internal Revenue Service (IRS) addresses the reporting requirements for large employers under the Affordable Care Act (ACA). Beginning in 2015, employers with more than 50 full-time employees are required to offer quality and affordable insurance to their employees. The new rule provides a methodology designed to simplify and reduce the costs associated with the employer reporting requirements mandated under the ACA. Another final rule issued by the IRS describes how issuers of minimum essential coverage are expected to report information to the IRS on the type and duration of coverage.

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CMS rule extends transition policy to 2016

Posted on March 6, 2014 | Comments Off

Yesterday, the Centers for Medicare and Medicaid Services issued the final rule on the Notice of Benefit and Payment Parameters for 2015. Several of the notable components of the rule include:

  • Extending the transitional policy from November 2013, which says that individuals may retain their insurance coverage even if it does not meet the Affordable Care Act (ACA) standards, through October 2016.
  • Finalizing that open enrollment for 2015 will being on November 15th, 2014 and conclude on January 15th, 2015.
  • Stabilizing the transitional reinsurance program by raising the attachment point and setting a reinsurance cap.
  • Refining the risk adjustment and risk corridor programs.
  • Implementing enrollee protections such as out-of-pocket limits and patient safety standards.
  • Finalizing provisions of the Small Business Health Options Program (SHOP) that address employee choice and premium aggregation.

In addition to the rule, Gary Cohen, the Director for the Center for Consumer Information and Insurance Oversight (CCIIO) released a letter explaining the extension of plans that do not meet the ACA meaningful coverage requirements. The letter further describes how states that did not implement this extension back in November may do so now.

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