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

Tag: Health and Human Services

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.

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HHS releases new FPL guidelines

Posted by Nikki Hurt on January 27, 2014

The US Department of Health and Human Services (HHS) updated the federal poverty level (FPL) guidelines for 2014. The guidelines, which are slightly higher than the 2013 levels, will not impact the eligibility thresholds used to determine subsidy eligibility for health insurance enrollment for 2014. For an individual, the the FPL is now set at $11,670, which represents a 1.6% increase from 2013.

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HHS releases enrollment figures

Posted by Nikki Hurt on January 13, 2014

The US Department of Health and Human Services (HHS) recently released enrollment figures from October 1st, 2013 to December 28th, 2013 for the Affordable Care Act’s (ACA) health insurance marketplace. Below are several of the key findings:

  • Nearly 2.2 million Americans have enrolled in health insurance;
  • About 24% of these individuals are between the ages of 18 and 34;
  • 60% of enrollees selected a silver plan; and
  • 79% of individuals selected a plan with financial assistance.

The most recent Assistant Secretary for Planning and Evaluation (ASPE) Issue Brief provides a detailed breakdown and explanation of the enrollment figures.

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HHS allows individuals with canceled plans to claim hardship exemptions

Posted by Nikki Hurt on December 30, 2013

The US Department of Health and Human Services (HHS) has permitted individuals whose insurance plans were canceled under the Affordable Care Act (ACA) to qualify for a hardship exemption and not be subject to the individual mandate for 2014. Hardship exemptions were created for individuals that experienced “financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan,” and the new decision by HHS places individuals with canceled health plans under this classification. The policy change, announced both in a letter to several senators and through official guidance from the Centers for Medicare and Medicaid Services (CMS), requires individuals with canceled plans to submit a hardship exemption form and proof of plan cancellation. Individuals choosing to claim a hardship exemption may forgo insurance for 2014 without a penalty or choose to enroll into catastrophic plans, which are bare-bones plans typically reserved for individuals under the age of 30.

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HHS releases progress and performance report for HealthCare.gov

Posted by Nikki Hurt on December 2, 2013

Yesterday, the US Department of Health and Human Services (HHS) released a progress report on the administration’s recent efforts to fix and improve the Affordable Care Act’s (ACA) website, healthcare.gov. The website has been plagued with issues and errors since its debut on October 1st. The document, HealthCare.gov: Performance and Progress Report, outlines all of the improvements and changes made to the website over the past two months. Some of these improvements include fixing over 400 bugs and software issues and updating the server so that the site may be able to host 800,000 visitors a day. The report cites management and collaborations issues, as well as inadequate systems and a multitude of technical software bugs, as key causes of the early site malfunction.

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106,185 enroll in health plans through ACA during October

Posted by Nikki Hurt on November 13, 2013

Today, the US Department of Health and Human Services (HHS) issued the first set of enrollment statistics for health insurance plans offered through the Affordable Care Act’s (ACA) Marketplaces. The report stated that 106,185 individuals signed up for coverage during the first month of open enrollment. About 75% of these individuals enrolled through State-Based Marketplaces. The remainder, about 26,000 people, reside in a state in which the Marketplace is operated by the federal government. While these individuals have completed the enrollment process, they have not necessarily purchased a plan.

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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.

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HHS posts premium rates for FFM states

Posted by Nikki Hurt on October 2, 2013

In an effort to help consumers circumvent the backlog to access plan information on federally-facilitated Marketplaces (FFM), the US Department of Health and Human Services (HHS) posted a list of 17,000 plans and premium rates that consumers may browse to see what options are available in their states. Plans are broken down by metal tier (platinum, gold, silver, and bronze), plan type (HMO, PPO, etc.), and the state and county in which the plan is offered. HHS has provided plan information for health insurance and stand-alone dental plans in the individual and small group markets.

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HHS sends letter to Energy and Commerce Majority in response to Navigator inquiry

Posted by Nikki Hurt on September 9, 2013

On August 29th, the House Energy and Commerce Committee sent a letter to 51 Navigator groups requesting answers to various questions on their roles and requirements under the Affordable Care Act (ACA). Today, the US Department of Health and Human Services (HHS) sent a letter to Chairman Fred Upton (R-MI) answering the questions posed by the committee. HHS stated that the timing of the committee’s letter may interfere with the ability of Navigator groups to perform their roles of outreach and education of health insurance options available to consumers through the ACA. Moreover, as the agency that granted and authorized Navigator groups, HHS has the information to answer the questions posed by Chairman Upton’s committee.

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Agencies issue another round of ACA FAQ

Posted by Nikki Hurt on September 5, 2013

On September 4th, the Departments of Labor, Health and Human Services, and Treasury jointly issued the sixteenth installment of their FAQs about implementing the Affordable Care Act (ACA). This particular set addressed employer notice of coverage and the 90-day waiting period limitation before employer-sponsored benefits are required to kick-in. As specifically stated in the FAQ, an employer will be considered to have satisfied the notice of coverage obligation if another entity “provides a timely and complete notice.” The FAQ also stated that employers can refer to the proposed rule issued in March 2013 on compliance expectations for the 90-day waiting period limitation. A final rule will be released before January 2015.

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