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
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.
CMS 2015 Draft Letter to Issuers in the Federally Facilitated Marketplace: Network Adequacy and Inclusion of Essential Community Providers
Posted on March 5, 2014
In administering the FFM, CMS utilizes Issuer Letters to apprise issuers potentially interested in offering qualified health plans (QHPs) in the Marketplace regarding priorities and policies for the agency. In effect, CMS acts like a plan sponsor in managing the FFM, although unlike other sponsors (e.g., employers), the FFM has not, to date, been selective about which plans may be sold in the Marketplace. That is, plans that meet FFM (and where applicable, state) certification standards are eligible to be sold. At the same time, QHPs must meet a range of certification standards, and in its oversight capacity, CMS uses its Issuer Letters as a means of clarifying policy and delineating areas of emphasis for health plans.
When Does Medicaid Coverage Amount to Minimum Essential Coverage Under the Affordable Care Act? An Update on the Treasury/IRS Rules Defining Minimum Essential Coverage
Posted on February 11, 2014
A January 27, 2014 proposed rule in the Federal Register (79 Fed. Reg. 4302-4308) published by Treasury/IRS would add further clarification to the question of under what circumstances the agencies will classify Medicaid as minimum essential coverage (MEC) for purposes of satisfying the Affordable Care Act’s requirement to maintain MEC or pay a shared responsibility tax. Comments are due by April 28, 2014; the agencies also intend to hold a public hearing on the NPRM which covers Medicaid as well as other types of coverage.
Update: Proposed IRS Procedures for Tax-Exempt Hospitals to Correct and Disclose Failures to Meet Their Community Benefit Obligations Under the Internal Revenue Code
Posted on January 13, 2014
In order to be exempt from federal income taxes, nonprofit hospitals seeking such a designation under the Internal Revenue Code must provide a community benefit, a policy that has been in place since 1969 but that has gone essentially unenforced since its creation by the Nixon Administration. Government estimates of the value of nonprofit hospital tax-exemption placed the total national value at more than $12 billion in 2002, a figure that undoubtedly has grown over the past decade and that reflects both federal tax losses and losses resulting from the fact that most states and localities use federal law to determine exemption from state and local property, sales, and income taxes…
Posted on January 7, 2014
On November 19, 2013, the Obama Administration published a Notice with comment that describes the overall Quality Rating System (QRS) framework for rating the quality of health plans (QHPs) sold in the health insurance Marketplace (another term for Exchanges). The purpose of the Notice is to solicit comments on the framework. Comments must be received by January 21, 2014. Comments are sought on both the proposed quality measures that QHP issuers would be expected to report, as well as on ways to preserve the integrity of QHP ratings and on areas for future measurement…
Posted on January 6, 2014
As discussed in earlier Briefs, the ACA requires all individual and non-grandfathered group health plans to cover certain preventive services, including comprehensive contraceptive services. On August 3, 2011, the Departments of Treasury, Labor, and Health and Human Services (HHS) published an Amended Interim Final Rule incorporating HRSA’s guidelines to require mandatory coverage by non-grandfathered group and individual insurance plans of all preventive services (including contraception) without cost sharing beginning on August 1, 2012. Religious employers and other interested parties argued that requiring employers to sponsor insurance that included contraception violated religious liberty…
Questions and Answers about the Administration’s Transition Plan to Address Health Insurance Policy Cancellations
Posted on November 18, 2013
On November 14th, 2013, the Obama Administration announced a plan to address a situation that began to emerge in earnest a number of weeks ago and that finally exploded into view within the past couple of weeks: people covered by individual insurance plans who were receiving notices from their insurers that their policies would be cancelled at the end of 2013 because they did not meet new coverage requirements set to take effect in January 2014. The number of people affected by policy cancellation notices is not clear, but most estimates suggest that one half or more of the 15 million people in the individual market could be affected. Manhattan Institute scholar Avik Roy placed the number at 4.8 million (so far). Washington Post reporter Sarah Kliff noted that the figure is hard to calculate but is likely to affect between 7 and 12 million people.
Posted on October 16, 2013
This Implementation Brief examines a Notice of Proposed Rulemaking (NPRM) issued by the Internal Revenue Service (IRS) on August 26, 2013 concerning the tax credit available to small employers that offer health insurance coverage to their employees…
Posted on October 10, 2013
By Taylor Burke Introduction On August 30, 2013, HHS published a final rule entitled “Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, and Eligibility Appeals.” This rule finalizes certain policies proposed in the Program Integrity NPRM published June 19, 2013, as well as certain policies proposed in the NPRM entitled “Essential Health Benefits [...]
Posted on October 3, 2013
On September 25, 2013, the Obama Administration published a Notice of Proposed Rulemaking in the Federal Register (78 Fed. Reg. 59122) that implements §1331 of the Affordable Care Act, which directs the Secretary to establish a Basic Health Program (BHP). The long-delayed proposed rule reflects extensive consultation with stakeholders, a Request for Information (76 Fed. Reg. 56767) published on September 14, 2011, and a series of “listening sessions” to gather input. The comment period runs until 5 p.m., November 25, 2013. This update provides a background on the BHP and summarizes the proposed rule…