Rulemaking, Rules, and Guidance
Posted on October 22, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a proposed notice on how the federal government will determine payment amounts for 2016 for states that decide to establish a Basic Health Program. The Basic Health Program is a voluntary option under the Affordable Care Act (ACA), which provides insurance to individuals between 133 and 200 percent of poverty through a separate program rather than having them go to the exchanges. The proposed notice says that states that establish the program will receive federal funding equal to 95 percent of the amount of premium tax credits and cost-sharing subsidies that would have otherwise been provided to those individuals for exchange plans. However, the funding does not cover states’ ongoing administrative or operational costs.
Posted on October 9, 2014
Guidance issued by the Centers for Medicare and Medicaid Services (CMS) advises states that that their capitated payment rates for Medicaid managed care plans should cover the costs of the Affordable Care Act’s (ACA) health insurance tax, as it is considered a “reasonable business cost.” The tax starts at $8 billion in 2014 and increases every year, up to $14.3 billion in 2018. Starting in 2019, the amount of the tax will increase annually based on premium trends. CMS contends that this fee is not unlike other taxes and fees that actuaries must take into account when developing capitation rates.
Posted on September 30, 2014
The Department of Labor (DOL) issued a final rule regarding excepted benefits and stand-alone dental and vision plans. In the original proposed rule if the wraparound coverage met a number of requirements, it would have been considered an excepted benefit that would not disqualify the employee from getting subsidized coverage on the exchanges. However, this language is excluded from the final rule issued. The DOL said it intends to publish regulations on the topic of wraparound coverage in the future, taking into account the extensive comments received on the topic.
Posted on September 19, 2014
The Internal Revenue Service (IRS) finalized a half-million-dollar cap on deductions that the biggest insurance companies can take for executive pay. This final rule will affect certain health insurance providers giving remuneration that exceeds the deduction limitation. According to a recent analysis, the little-known Affordable Care Act (ACA) provision amounted to about $1.3 million per executive for the largest insurers in 2013. The rule details what companies and employees are subject to the limit and how it should be applied.
Posted on September 3, 2014
The US Department of Health and Human Services (HHS) released a final rule on eligibility and re-enrollment for the second open enrollment season of the Affordable Care Act (ACA). The rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of the state.
Posted on August 29, 2014
The Internal Revenue Service (IRS) posted a set of draft instructions to accompany the employer mandate and exchange filing forms released last month. The instructions are directed at marketplaces that have to report enrollees in qualified health plans, as well as employers and others that provide minimum essential coverage or are subject to the employer mandate.
Posted on August 25, 2014
The U.S. Department of Health and Human Services (HHS) published an interim final rule which provides an alternative process for an eligible organization to provide notice of its religious objections to providing contraceptive coverage. It will allow qualifying organizations to notify HHS of their religious objections to providing coverage and the government will in turn contact their insurers, which are to provide contraceptive benefits to the employees without any cost sharing. HHS additionally released a proposed rule which changes the definition of an eligible organization that can avail itself of an accommodation with respect to coverage of certain preventive services. These rules come in response to recent decisions against the Affordable Care Act’s (ACA) birth control mandate from multiple federal courts. HHS also released a coinciding fact sheet on the rules.
Posted on August 15, 2014
The Centers for Medicare and Medicaid Services (CMS) released a bulletin updating the Navigator, non-Navigator assistance personnel, and certified application counselor training curriculum for the Federally-facilitated and State Partnership Marketplaces in preparation for the next Open Enrollment Period beginning November 15, 2014. The expanded curriculum will include more information on immigration, household income calculations and help for specific populations, including victims of domestic abuse and college students. All assisters, whether they are seeking recertification or initial certification, will be required to complete the new training program.
Posted on August 5, 2014
The Centers for Medicare and Medicaid Services (CMS) issued a final rule revising the Medicare hospital inpatient prospective payment systems (IPPS). In adherence to the Affordable Care Act (ACA), part of the rule would effectively reduce payments to disproportionate share hospitals (DSH), which serve the most vulnerable patients. DSH payment reductions are a result of the expansion of Medicaid, however in states that chose not to expand, hospitals still risk losing some payment for uncompensated care.
Posted on July 24, 2014
The Center for Consumer Information and Insurance Oversight (CCIIO) and the Centers for Medicare & Medicaid Services (CMS) issued Federal guidance which gives individuals a three-month grace period to pay a premium without losing coverage. However, the same guidance states that if individuals choose enroll in a new policy for 2015, insurance companies cannot apply new premiums to outstanding 2014 debt. Some have suggested that this inconsistency could allow consumers to avoid paying their December premiums. However, nothing bars an insurer from making a bona fide effort to collect any unpaid premiums, as the consumer would still owe this amount to the insurer.