Tag: Final Rule
CMS releases BHP final rule
Posted by Nikki Hurt on March 7, 2014
The Centers for Medicare and Medicaid Services (CMS) released a final rule and payment notice for the Basic Health Program (BHP). Under the Affordable Care Act (ACA), many individuals will have an income too high to qualify for Medicaid, yet subsidies may not make their health insurance affordable. BHP, a program aiming to reduce churning between Medicaid and private coverage, helps to ensure continuity of care for individuals with fluctuating incomes. The rule allows for states to receive funding for BHP beginning in 2015.
CMS rule extends transition policy to 2017
Posted by Nikki Hurt on March 6, 2014
Tri-agency rules address 90-day waiting period limit
Posted by Nikki Hurt on February 20, 2014
The US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released several rules today concerning the 90-day waiting period limitation before insurance coverage can become effective. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days beginning January 2015. The proposed rule clarifies the 90-day limitation in terms of the length of employment-based orientation periods, stating that one month is the reasonable limit for employment-based orientation periods.
IRS issues two ACA rules
Posted by Nikki Hurt on November 29, 2013
The Internal Revenue Service (IRS) published two final rules concerning the implementation of the Affordable Care Act (ACA). The first rule outlines the health insurance provider fees firms in the insurance industry are expected to provide annually, beginning in 2014. These fees are anticipated to raise nearly $60 billion in revenue over the next several years, most of which will be used as subsidies for qualifying individuals to purchase insurance through health insurance marketplaces. The fee applies to insurance companies with annual revenues exceeding $25 million. Nonprofit insurers receiving more than 80% of their funds from the government, self-insured corporations, and government entities are all excluded from the fee.
The second rule addresses the Additional Medicare Tax provision of the ACA, which requires an additional hospital insurance tax on individuals with incomes above the specified threshold. The rule concerns the implementation and integration of the Additional Medicare Tax, specifically highlighting certain wages and compensation to which the tax does not apply, filing a tax return, and employer processes for adjusting payments and filing claims under the Additional Medicare Tax.
Administration issues mental health final rule
Posted by Nikki Hurt on November 8, 2013
The Department of Health and Human Services (HHS), Department of Labor (DoL), and the Department of the Treasury (DoT) released the joint final rule implementing the Mental Health Parity and Addiction Equity Act of 2008. Under this law, insurers that offer coverage for mental health services are expected to treat mental health equitably, meaning cost-sharing and limits for mental health services should be comparable to that of physical health services. Several other specific provisions addressed in this rule include:
- Parity for intermediate care offered in residential or outpatient settings and all plan standards (i.e. network adequacy and geographic limits);
- Clarifying transparency expectations for insurers to remain compliant with the law; and
- Eliminating provisions that enabled insurers to make exceptions for parity requirements for certain benefits offered.
The law was passed in 2008, and an interim final rule was issued in January 2010. The Centers for Medicare and Medicaid Services (CMS) also published an FAQ on today’s rule.
Update: Medicaid DSH Final Rule
Posted by Nikki Hurt on October 8, 2013
On September 13th, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a final rule concerning the reduction of Medicaid Disproportionate Share Hospital (DSH) payments to hospitals. The reduction methodology discussed in this rule will be effective for FY 2014 and FY 2015…
OPM final rule requires Members and staff to enroll in DC SHOP
Posted by Nikki Hurt on September 30, 2013
Today, the Office of Personnel Management (OPM) released a long-awaited final rule describing how Congressional Members and their staff will obtain coverage under the Affordable Care Act (ACA). OPM stated that Members and their aides, regardless of where they reside, will enroll in the DC Small Business Health Options Program (SHOP). In doing so, they will retain their employer contribution from the federal government, but will not be eligible for federal subsidies like those partaking in the individual insurance market. Members have until October 31st to determine which staff members are considered “official office staff” and are therefore required to enroll in SHOP. Committee staff will keep their coverage on the Federal Employees Health Benefits program.
A fact sheet provided to Congressional Members and their staff succinctly explains the changes instituted by OPM.
SHOP, designed to promote and facilitate the enrollment of small business employees into group health plans, will be fully operational tomorrow, October 1st.
CMS releases final DSH rule for safety net hospitals
Posted by Nikki Hurt on September 13, 2013
In a final rule released today, the Centers for Medicare and Medicaid Services (CMS) stated that hospitals treating large low-income populations will begin to see a decline in their Disproportionate Share Hospital (DSH) payments. Typically, DSH payments are provided to hospitals that treat many uninsured and low-income populations as a means to offset some of the costs of rendering uncompensated care. DSH payments were set to decrease under the Affordable Care Act (ACA), as the individual mandate and expanded Medicaid eligibility requirements should have reduced the uninsured population. The Supreme Court ruling that state Medicaid expansion is optional hampered this goal, and a CMS fact sheet on the rule claimed that a state’s decision on whether or not to expand Medicaid will not influence the allotment of DSH payment hospitals in that state will receive. In total, CMS will cut $1.1 billion in DSH payments over the next two years.
CMS publishes program integrity final rule
Posted by Nikki Hurt on August 28, 2013
The Centers for Medicare and Medicaid Services (CMS) released a final rule today implementing a multitude of provisions within the Affordable Care Act (ACA). The final rule, which has remained largely unchanged from the program integrity proposed rule published in June, provides policies designed to protect consumer information and ensure appropriate usage of federal funds. Specifically, the rule requires oversight of qualified health plan (QHP) issuers on federally-facilitated Marketplaces and oversight of privacy and security measures instituted on state-based Marketplaces. The rule also covers eligibility appeals for the individual and small business health options program (SHOP) markets.
The Center for Consumer Information and Insurance Oversight (CCIIO) within CMS concurrently released a fact sheet that outlines the key provisions discusses in the final rule.
IRS posts final rule on minimum essential coverage penalty
Posted by Nikki Hurt on August 27, 2013
A final rule released by the Internal Revenue Service (IRS) explains the individual shared responsibility payment for not obtaining basic insurance coverage, or minimum essential coverage, under the Affordable Care Act (ACA). By 2014, most Americans are expected to possess minimum essential coverage or face a tax penalty under Section 5000A of the Internal Revenue Code. Individuals without minimum essential coverage will pay an annual fine of $95 in 2014, $325 or 2% of their income in 2015, and $695 or 2.5% of their income in 2016 and beyond. Since many Americans will be exempt from this provision for a multitude of reasons (hardship, unaffordability, religious beliefs, etc.), the Congressional Budget Office (CBO) estimates that only 2% of Americans will face the penalty.
In addition to the final rule, the IRS released a fact sheet that highlights several of the key points addressed in the rule. The fact sheet discusses how the rule clarifies hardship exemptions and partial month coverage (i.e. an individual has maintained minimum essential coverage as long as he or she has coverage for at least one day of the month). Specific coverage categories to which minimum essential coverage provisions apply are enumerated, and the processes for obtaining an exemption are also described.