A project of the George Washington University's Hirsh Health Law and Policy Program and the Robert Wood Johnson Foundation

Rulemaking, Rules, and Guidance

IRS issues guidance on coverage of hospital services

Posted on November 5, 2014

New guidance issued by the Internal Revenue Service (IRS) states that employers must provide substantial coverage for in-patient hospitalization services in order to meet minimum Affordable Care Act (ACA) standards. Plans that fail to provide this coverage do not provide the minimum value intended by the minimum value requirement of the ACA. According to the guidance, any employer that has contracted with such a plan before this guidance was issued will be excluded from the requirement in 2015 if its plan year begins on or before March 1.

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CMS issues Basic Health Program information for 2016

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.

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CMS issues guidance on ACA health insurance tax

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.

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DOL issues final rule on excepted benefits

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.

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IRS issues final rule on ACA write-off limit

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.

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HHS releases final rule on ACA eligibility and re-enrollment

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.

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IRS posts employer mandate filing instructions

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.

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HHS publishes rules on contraception coverage

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.

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CMS announces updated training program for ACA navigators

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.

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CMS publishes Medicare pay final rule

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.

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