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Tag: Health Insurance Reforms

Obama administration announces $150 million in funding to CHCs for in-person enrollment assistance

Posted by Mark Dorley on May 9, 2013

Today the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) announced the awarding of $150 million in funding to the nation’s 1200 community health centers for the purposes of providing in-person enrollment assistance under the Affordable Care Act (ACA). With these new funds, health centers will be able to hire new staff, train existing staff, and conduct community outreach events and other educational activities in order to help provide in-person enrollment assistance to uninsured individuals across the country, according to the agency press release here. The full funding announcement, which contains detailed breakouts of the dollar amounts awarded to specific health centers, can be found here.

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Sub-Regulatory Guidance Regarding Age Curves, Geographical Rating Areas and State Reporting

Posted by Nikki Hurt on May 1, 2013

This Age Curve portion of the sub-regulatory guidance reminds states that in the absence of a state-established and HHS-approved uniform age rating curve for the purpose of age rating in the individual and small group markets, a federal default standard will apply. The statute and final rule require that the premium rate charged by an issuer in the individual and small group market (for non-grandfathered plans) may vary by age, but not by more than a 3:1 ratio for adults. Moreover, the final rule defines, and the sub-regulatory guidance reiterates, the standard age bands for insurance rating purposes as follows…

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Multi-State Health Plans: The Final Rule

Posted by Nikki Hurt on April 3, 2013

The state health insurance exchanges are designed to provide consumers choices among pre-approved health plans that meet certain federal standards ranging from the provision of specific benefits to anti-discriminatory requirements for pre-existing health conditions. Only plans that meet these standards – the qualified health plans, or QHPs – will be allowed to participate in the exchanges. To further foster competition, the ACA also requires two QHPs participating in each exchange to be multi–state plans…

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Update: Essential Health Benefits Final Rule

Posted by Mark Dorley on March 13, 2013

On February 25th, 2013, final regulations implementing the essential health benefit (EHB) provisions of the Affordable Care Act were published in the Federal Register (78 Fed. Reg. 12834-12872). The EHB rules, which amend 45 C.F.R., apply to all non-grandfathered individual and small group health plans sold after January 1, 2014, as well as Medicaid benchmark and benchmark-equivalent health plans. The EHB rules also apply to…

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CMS and IRS release rules on exemptions to individual mandate, penalties

Posted by Mark Dorley on January 31, 2013

The Internal Revenue Service (IRS) and the Centers for Medicare and Medicaid Services (CMS) have released 2 new proposed rules related to the individual requirement to purchase health insurance (mandate). The IRS rule clarifies the requirement that nonexempt individuals maintain minimum essential coverage or make a shared responsibility payment (penalty). The CMS rule lays out specific exemptions to minimum coverage requirement, most notably that any person otherwise eligible for Medicaid under the new ACA eligibility expansion, but who resides in a state that has chosen not to expand, will not be subject to the shared responsibility payment.

Stay tuned to HealthReformGPS for a detailed analysis of these rules in the future.

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HHS releases single streamlined insurance marketplace application, solicits comment

Posted by Mark Dorley on January 29, 2013

The Centers for Medicare and Medicaid Services (CMS) has released a draft of the single, streamlined applications for both individual health insurance coverage and the SHOP applications, in preparation for the launch of the new Health Insurance Marketplace (formerly known as the Exchange) next fall. Model applications and documentation for individuals and for the small business health options program (SHOP) are now available for public comment via the paperwork reduction act (PRA).

The individual application is a single point of entry to purchase private insurance through the Marketplace and assess eligibility for assistance, including Medicaid, CHIP, and the Advanced Premium Tax Credits (PTCs). CMS has asked that people review the paper and online applications and provide feedback in the way of comments, which can be done by accessing the documents at the PRA website here.

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Update: Shared Responsibility for Employers Regarding Health Coverage

Posted by Mark Dorley on January 23, 2013

On January 2, 2013, the Department of Treasury issued proposed regulations (78 Fed. Reg. 218) that describe in detail the standards that will be applied in determining which employers are covered by the Affordable Care Act’s “shared responsibility” requirements covering large employers. The proposed rules, which build on earlier guidance issued over the 2011-2012 time period, interpret §4980H of the Internal Revenue Code, as added by the ACA. This section provides…

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Update: Health Insurance Reforms and Rate Review

Posted by Mark Dorley on December 10, 2012

The Patient Protection and Affordable Care Act (ACA) included health insurance market reforms designed to ensure that individuals and small businesses could not be denied coverage or be charged significantly higher premiums because of an individual’s health status. While some of the market reforms enacted in the ACA were designed to go into effect shortly after enactment (e.g., requiring issuers and employer-sponsored plans to cover adult children up to age 26 on a parent’s health plan, and limiting pre-existing condition exclusions) the most sweeping reforms…

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Essential Health Benefits Update: Proposed Regulations Implementing the ACA; and Application of the Proposed EHB Regulations to Medicaid Benchmark Plans

Posted by Mark Dorley on November 29, 2012

On November 26, 2012, the Obama Administration published a series of proposed rules implementing many of the Affordable Care Act’s (ACA) most important insurance reforms, including Health Insurance Market Rules and Rate Review (77 Fed. Reg. 70584), Nondiscriminatory Wellness Programs in Group Health Plans (77 Fed. Reg. 70620), and Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation (77 Fed. Reg. 70644). In addition, the Administration issued informal guidance that add to and amplify on the provisions of the proposed rules.

This Implementation Brief Update examines the proposed rule implementing the Act’s essential health benefits…

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Sebelius grants RGA request for more time to decide on a state-run exchange

Posted by Mark Dorley on November 16, 2012

Late yesterday, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius extended the deadline for states to decide whether to run their own exchange until December 14, 2012. The Republican Governors Association (RGA) sent a letter requesting the extension to Sebelius on Wednesday November 14, 2012, just two days prior to the initial deadline. This is the second time in a week that the Secretary has made extensions to key Exchange deadlines, having also recently extended the deadline to submit the state-run exchange blueprint paperwork (also December 14, 2012) and the deadline of whether a state will choose to partner with the federal government on their exchange (February 15, 2013).

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