Tag: Rulemaking
Update: Medical Loss Ratio Requirements
Posted by Mark Dorley on May 15, 2012
On May 11, 2012, the United States Department of Health and Human Services (HHS) issued a final rule that revises previous medical loss ratio (MLR) rules to establish consumer notification requirements with which insurers must comply when meeting applicable MLR requirements. In a previous December, 2011 final rule governing other aspects of the MLR amendments, HHS had required notification only when insurers did not …
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Update: Essential Health Benefits FAQs
Posted by Mark Dorley on May 9, 2012
In February 2012, CMS issued a supplemental document entitled Frequently Asked Questions on Essential Health Benefits Bulletin. This supplement to the December 16th Bulletin provides answers to 22 questions arising from the December 16th Bulletin itself. Highlights are as follows:
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Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update
Posted by Mark Dorley on April 20, 2012
This update to our March 2012 implementation brief reviews recent implementation efforts by the Administration in connection with coverage of contraceptives as a required element of required preventive services for all individual and (non-grandfathered) group health plans under the Affordable Care Act. The earlier brief reviewed the Administration’s final rules defining the scope of contraception coverage, as well as the scope of the religious exemption that would apply to employers that seek an exemption from this coverage requirement. Reflecting prior law on this matter, the final rule preserved…
Administrative Simplification: Adoption of Operating Rules for Health Plan Eligibility and Health Care Claim Status Transactions
Posted by Mark Dorley on April 13, 2012
On July 8, 2011 the Secretary of the Department of Health and Human Services (HHS) issued an Interim Final Rule with Comment Period (IFR) regarding the operating rules for two types of HIPAA transactions: eligibility for a health plan and health care claim status. The rules are in response to Section 1104 of the Affordable Care Act (ACA), which directed the Secretary to adopt certain operating rules for transactions to enable electronic health information exchange and create greater uniformity in the transmission of health information.
The ACA defines operating rules as…
Update on the Final Rule: Standards Related to Reinsurance, Risk Corridors and Risk Adjustment
Posted by Mark Dorley on April 4, 2012
The reinsurance, risk corridor and risk adjustment programs, established under the ACA at sections 1341, 1342 and 1343, respectively, were developed to mitigate possible health insurance adverse selection and to maintain stable premiums in the individual and small group markets as implementation of the ACA’s insurance market reforms and health insurance Exchanges begin in 2014. Under ACA section 1341, each state must establish a temporary reinsurance program for years 2014-2016 to help stabilize premiums for coverage of high-risk individuals in the private market. Section 1342 of the ACA requires the HHS Secretary to establish a temporary risk corridor program…
Update: Highlights from the Final ACA Medicaid Eligibility Regulations
Posted by Mark Dorley on March 23, 2012
On March 16, 2012 the Centers for Medicare and Medicaid Services (CMS) released a final rule regarding Medicaid eligibility under the Affordable Care Act. A summary of the final rule was previously posted on healthreformgps.org. This Update summarizes the key provisions of the final regulation, which also contains certain interim final rules on which further comment is sought.
The Final Rule, which takes effect January 1, 2014, addresses a wide array of issues raised in the 2011 proposed rule.
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Sebelius announces additional time for religious employers to comply with contraception coverage requirement
Posted by Mark Dorley on January 20, 2012
US Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that religious non-profit employers who do not currently offer contraceptive coverage to their employees will have an additional year to comply with the preventive services requirement set forth in an earlier Interim Final Rule (IFR). The earlier rule requires, that as of August 1, 2012, all employers except for churches must include contraception among the free preventive services covered in the insurance plans they offer to employees. The new announcement allows those employers who have religious objections an additional year to comply with the requirement.
For more information on preventive services, click here.
Update to Consumer Operated and Oriented Plan (CO-OP) Program: Final Rule
Posted by Mark Dorley on January 18, 2012
The Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing the Consumer Operated and Oriented Plan (CO-OP) Program on December 13, 2011. This rule finalizes the notice of proposed rulemaking (NPRM) issued by CMS on July 20, 2011, and takes into consideration the numerous comments received during the public notice and comment period ending September 16, 2011. Established by §1322 of the Affordable Care Act (ACA), the CO-OP program develops and creates new private, non-profit health insurance issuers to offer qualified health plans (QHPs) through state Exchanges as an alternative for consumers to traditional, for-profit plans. CO-OP plans are consumer-run, and accountable to their individual membership in a way that most traditional for-profit health plans typically are not. The ACA requires HHS to award funds for start-up loans and solvency grants to eligible CO-OP applicants in order to enable each state to have at least one CO-OP. In making these awards, HHS must take into account recommendations from the Advisory Board created by ACA §1322(b)(2). Two previous Implementation Briefs provided an overview of the CO-OP program and set forth the key provisions of the proposed rule; this update describes significant changes to the proposed rule as codified in the final rule.
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IRS releases Draft Schedule H, instructions for tax-exempt hospitals
Posted by Mark Dorley on January 6, 2012
The Internal Revenue Service (IRS) has issued a draft Schedule H and accompanying instructions for tax-exempt hospitals. As required by the Affordable Care Act (ACA), non-profit hospitals must respond to questions on financial assistance policies, billing and collection practices, emergency medical care, and individuals eligible for financial assistance, beginning with the 2011 tax filing year. The draft instructions have been revised to more clearly follow the statutory provision of Section 501(r) of the Internal Revenue Code. Several of the changes relate to billing and collections.
For more information on tax-exempt hospital requirements, click here and here.
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Update: Essential Health Benefits
Posted by Mark Dorley on December 20, 2011
On December 16, 2011, the HHS Center for Consumer Information and Insurance Oversight (CCIIO) released an Essential Health Benefits Bulletin, whose purpose is to “provide information and solicit comments on the regulatory approach that the Department of Health and Human Services (HHS) plans to propose to define essential health benefits under section 1302 of the Affordable Care Act.” Comments on the Bulletin can be sent directly to EssentialHealthBenefits@cms.hhs.gov and will be accepted until January 31, 2011
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Most Popular Content
- Update: Essential Health Benefits FAQs posted on May 9, 2012
- Update: Exchanges Establishment and Eligibility Final Rule posted on April 10, 2012
- Contraception Coverage under the ACA’s Preventive Services Coverage Requirements, and Employer Implementation: An Update posted on April 20, 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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- Update: Medical Loss Ratio Requirements
