CMS releases draft application for ACA exemptions
Posted on October 16, 2013 | No Comments
The Centers for Medicare and Medicaid Services (CMS) issued a draft application and a corresponding data collection comment request concerning exemptions from the individual mandate. Under the Affordable Care Act (ACA), certain groups of individuals, such as those experiencing financial hardships or those that belong to a religious organization that opposes the use of insurance, are deemed exempt from the individual mandate and are therefore not required to pay the $95 penalty in 2014. This specific draft application, which is for individuals requesting a hardship exemption, is 6 pages in length and requires applicants to provide the type of hardship they are experiencing and their tax information. CMS anticipates that more than 12 million individuals will apply for the individual mandate exemption. The data collection comment request outlines options for states to rely on the Department of Health and Human Services (HHS) to determine eligibility exemptions, and asks the Office of Management and Budget (OMB) to approve the annual information collection requirements associated with the application.
- Eligibility determination and granting of certificates of exemption. This rule implements provisions of the ACA associated with eligibility determination, while still leaving states ample discretion in creating their Exchanges. The rule standardizes tenets of eligibility determination that are explicitly stated in the law and are necessary for efficiency and consumer protection. The rule also states that individuals that would be eligible for Medicaid had their state chosen to expand will not be subject to the individual mandate penalty.
- Designation of benefits as minimal essential coverage. This rule provides guidance for determining whether certain types of coverage, particular those not explicitly defined in the statue, can be considered minimum essential coverage. If this these other types of coverage are certified as compliant with Title I of the ACA, then consumers possessing this coverage will be considered to have met the minimum essential coverage requirements.
- Premium tax credit eligibility and shared responsibility exemption. Guidance released by the Internal Revenue Service (IRS) expanded upon eligibility criteria for minimum essential coverage of individuals on government-sponsored health programs, student health programs, or state high risk pools. Additional IRS guidance purports that an individual may be relieved of shared responsibility payments if he or she is transitioning to an employer-sponsored plan during a non-calendar year.