Office of Consumer Information and Insurance Oversight
CCIIO announces potential plans for risk adjustment
Posted on May 17, 2012
The Center for Consumer Information and Insurance Oversight (CCIIO) recently announced that the U.S. Department of Human Services (HHS) may use a a concurrent model for risk adjustment. The overall goals of the risk adjustment model are to mitigate impacts of adverse selection and stabilize premiums in the individual and small group markets.
HHS will use the Hierarchical Condition Category (HCC) classification system as a basis for the HHS risk adjustment model. This model utilizes diagnoses from all physician and hospital encounters, and profiles beneficiary medical problems with diagnostic categories (HCCs) that are not mutually exclusive. HCC classification provides a diagnostic framework for developing a risk adjustment model to predict medical spending and plan accordingly.
The concurrent risk adjustment model, if implemented, will use diagnoses in the current year to predict expenditures for that same year. Importantly, HHS plans to select a different set of HCCs for the Federal risk adjustment methodology than those used in Medicare to reflect the differences in population.
HCC was originally developed for CMS to do risk adjustment for Medicare Advantage and Part D prescription drug plans. The model will have to be adapted for the Affordable Care Act’s (ACA’s) risk adjustment due to the presence of the private insurance market.
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HHS publishes Exchange guidance and draft blueprint
Posted on May 16, 2012
The US Department of Health and Human Services (HHS) published guidance today on the implementation of the federally-run fallback exchange that the government will run in states that are not ready to operate a state-run exchange. In addition to the higher level operational approach, the paper also discusses how states can partner with HHS to implement selected functions in a Federally-facilitated Exchange (FFE), key policies organized by Exchange function, and how HHS will consult with a variety of stakeholders to implement an FFE. HHS also released a draft blueprint for approval of state-based or state-federal partnership exchanges. State exchanges must be certified by HHS by the beginning of 2013.
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HHS releases bulletin on essential benefits, allows for state flexibility
Posted on December 16, 2011
The U.S. Department of Health and Human Services (HHS) has issued a pre-rule informational Bulletin which lays out its proposed approach for determining the Essential Benefits package required of all qualified health plans (QHPs) under the Affordable Care Act (ACA). HHS deferred to States’ judgment by allowing a State to create a benchmark essential benefits package from a currently-available plan within the State, as long as the package includes benefits from the ten benefit categories laid out in the ACA. HHS proposes that States choose the benchmark plan from a list of plan types:
- One of the three largest small group plans in the State by enrollment
- One of the three largest State employee health plans by enrollment
- One of the three largest federal employee health plan options by enrollment
- The largest HMO plan offered in the State’s commercial market by enrollment
If a State does not select a benchmark plan, HHS intends to propose that the default benchmark be the benefits package from the largest small group plan within the State.
For more information on Essential Benefits, click here.
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HHS issues amended final rule on rate review, association plans subject to reviews
Posted on September 6, 2011
The U.S. Department of Health and Human Services (HHS) has issued an amended final rule clarifying the definition of “individual market” and “small group market” with respect to the rate review process authorized by the Affordable Care Act (ACA). The definition now includes association plans in the types of health insurance products that are subject to the rate increase disclosure rules ad reviews, even if States do not chose to regulate association plans as part of their own individual or small group markets.
For more information on the disclosure and review of insurance premiums under the ACA, click here.
HHS moves key health reform office to Medicare agency
Posted on January 5, 2011
In a letter to House Appropriations Committee Chairman Harold Rogers, Health and Human Services (HHS) Secretary Kathleen Sebelius notified Congress that HHS will move the Office of Consumer Information and Insurance Oversight (OCIIO) into the Centers for Medicare and Medicaid Services (CMS). Formerly within the Office of the Secretary (OS), OCIIO will be renamed as the Center for Consumer Information and Insurance Oversight when moved to CMS, and will continue to carry out its original function.
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HHS issues mini-med guidance
Posted on December 10, 2010
The Department of Health and Human Services has issued guidance on the one-year waiver granted to “mini-med” plans on new regulations concerning annual coverage limits. The sale of such plans are restricted to limited circumstances and insurers are required to “notify consumers in plain language that their plan offers extremely limited benefits and direct them to www.HealthCare.gov where they can get more information about other coverage options.”
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Agency Profile: Office of Consumer Information and Insurance Oversight
Posted on November 29, 2010
The responsibilities for implementing the Affordable Care Act are spread across several federal departments and the offices within them. This is the latest in a series of briefs developed by HealthReformGPS describing the implementing agencies and their roles.
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HHS releases Medical Loss Ratio Interim Final Rule
Posted on November 22, 2010
The Department of Health and Human Services Office of Consumer Information and Insurance Oversight (OCIIO) has released an interim final rule with request for comment implementing the medical loss ratio requirements for health insurance issuers under the health reform law. Along with the regulation, OCIIO released a fact sheet and Regulatory Impact Analysis Technical Appendix.
For more, visit our updated Medical Loss Ratio Implementation Brief.
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Grandfathered plans IFR amendment, request for comment
Posted on November 16, 2010
On November 17, amendments to the interim final rule (IFR) on grandfathered plans will be published in the federal register with request for comment. The major change it makes to the IFR is that it will allow employers to change issuers without losing grandfathered status.
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HHS approves an additional 1,000 employers and unions for early retiree reinsurance program
Posted on October 5, 2010
The Department of Health and Human Services has announced that nearly an additional 1,000 employers and unions have been approved for the early retiree reinsurance program, bringing the total to almost 3,000 since the program launched in August. The health reform law made available five billion dollars to assist employers and unions maintain coverage for retirees over 55 not yet eligible for Medicare until the exchanges kick in in 2014.
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- Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update posted on April 20, 2012
- Update: Essential Health Benefits FAQs posted on May 9, 2012
- Update: Exchanges Establishment and Eligibility Final Rule posted on April 10, 2012
- State Health Insurance Exchange Navigators posted on February 28, 2011
- Update on the Final Rule: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment posted on April 4, 2012
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