The Centers for Medicare and Medicaid Services (CMS) today released a proposed rule on benefits and payment under the Affordable Care Act (ACA). The proposed rule outlines how CMS plans to run federal exchanges and suggests how risk adjustment data should be collected. The rule also lays out the three-year transitional program that the federal government will run to maintain premium costs in the individual market, and projected that premiums will be 10 to 15 percent lower than they would have been without the reinsurance program. With regard to the reinsurance program, CMS said that federal exchanges can impose a user fee on health plans to finance the exchanges. However, to prevent the user fees from making the health plans less attractive, CMS is asking the Office of Management and Budget (OMB) to exempt the requirement that those fees cover the whole cost in 2014. Before 2014, it wants to cap the monthly fee rate at "3.5 percent of the monthly premium charged by the issuer for a particular policy under the plan." The goal of the rule is to stabilize the new exchange market, limit risk, and smooth over the transition. Comments on HHS’s proposed rule are due December 31.

A draft of a multi-state plan application indicates that the Office of Personnel Management intends to allow the Affordable Care Act's (ACA's) multi-state plans to initially participate in part of a state, as opposed to the entire state. This comes as a surprise, as the ACA states that multi-state plans must be offered "in all geographic regions..." According to the ACA provision, these multi-state plans must be operating in 60 percent of states in the first year of an insurance plan's participation. By the fourth year, they must scale up and offer coverage nationwide. These plans will be certified to be offered in all exchanges, so they will not need to apply for separate state certifications. Comments on the draft application are due to OPM by October 22, 2012.