CMS issues final rule on benefit and payment parameters for 2016
Posted by Sara Rothenberg on February 23, 2015
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on the U.S. Department of Health and Human Services (HHS) Notice of Benefit and Payment Parameters for 2016. The final rule builds on previously issued standards to further strengthens transparency, accountability, and the availability of information for consumers about their health plans. The rule finalizes the annual open enrollment period for 2016 to begin on November 1, 2015 and run through January 31, 2016. CMS also released its final annual letter to issuers, which provides additional guidance on these and related standards for plans participating in the Federally-facilitated Marketplace.
HHS issues proposed rule on summary of benefits and coverage
Posted by Sara Rothenberg on January 5, 2015
The U.S. Department of Health and Human Services (HHS) issued a proposed rule, simultaneously released by the Internal Revenue Service (IRS) and the Department of Labor (DOL), regarding the summary of benefits and coverage (SBC) and the uniform glossary for health insurance coverage in the group and individual markets under the Affordable Care Act (ACA). The proposed rule would change disclosure requirements to help plans and individuals better understand their health coverage and allow for informed comparisons of coverage options. The proposed regulation also makes amendments to the template for the SBC, instructions, sample language, guides for coverage example calculations, and the uniform glossary.
HHS releases proposed rule on open enrollment
Posted by Sara Rothenberg on November 22, 2014
The U.S. Department of Health and Human Services (HHS) issued a proposed rule that would set future annual exchange open enrollment periods so that they begin October 1 and end December 15. Consumers selecting a plan during this time period would gain coverage starting January 1, 2016. HHS says this time period will be long enough for consumers to pick or change their plan, but not crossing calendar years will reduce consumer confusion. The proposed rule also touches on key aspects of the Affordable Care Act (ACA), including risk corridors, user fees for the federal exchange, essential health benefits, and network adequacy.
HHS releases final rule on ACA eligibility and re-enrollment
Posted by Sara Rothenberg 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.
OIG releases report on federal exchange contracts
Posted by Sara Rothenberg on August 26, 2014
The US Department of Health and Human Services (HHS) Office of the Inspector General (OIG) released a report which provides an overview of the contracts that contributed to the development of the Federal Marketplace. The Centers for Medicare and Medicaid Services (CMS) relied, and continues to rely, extensively on contractors to operate the Federal Marketplace under the Affordable Care Act (ACA). The report analyzes the planning, acquisition, management, and performance oversight of these contracts, but does not make recommendations.
HHS publishes rules on contraception coverage
Posted by Sara Rothenberg 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.
IG reports examine ACA enrollment applications
Posted by Nikki Hurt on July 1, 2014
The US Department of Health and Human Services Office of the Inspector General (OIG) released two new reports concerning enrollment into qualified health plans (QHP) under the Affordable Care Act (ACA). The first report found that the vast majority of application inconsistencies were not resolved within the first three months of the open enrollment period. According to the report, many of the inconsistencies dealt with reported income and citizenship status, and states are at various points in rectifying these application data inconsistencies.
Another report investigated whether or not federally-facilitated Marketplaces (FFM) and two state-based Marketplaces (SBM) were able to verify enrollment eligibility. During the same three month window, OIG found that the FFM was not able to verify social security numbers. For the SBM states, California and Connecticut, the report found that both states also had some ineffective controls in regards to confirming various aspects of QHP enrollment.
Rule finalizes 90-day waiting limit
Posted by Nikki Hurt on June 20, 2014
Today, the US Department of Health and Human Services (HHS), the Internal Revenue Service (IRS) and the Employee Benefits Security Administration (EBSA) released a final rule concerning the 90-day waiting period limitation. The final rule states that group health insurance plans cannot apply a waiting period that exceeds 90 days after the employee has been approved for coverage. The rule further states that small group plan orientation periods, the time it takes from hire to when the plan deems the employee is eligible for coverage, cannot exceed one month.
ASPE report indicates premium variation among states
Posted by Nikki Hurt on June 18, 2014
A new report by the US Department of Health and Human Services (HHS) describes how premiums vary among the 36 states operating federally-facilitated Marketplaces under the Affordable Care Act (ACA). The report, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) within HHS, found the average premium payment by an individual receiving subsidies to be $82, with the subsidized average for the silver plan metal tier being $69. Average subsidized premiums ranged from $23/month in Mississippi to $148/month in New Jersey. The report does not capture the corresponding data for the state-based Marketplaces.
HHS releases final Marketplace rule
Posted by Nikki Hurt on May 16, 2014
The US Department of Health and Human Services (HHS) issued a final rule entitled Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond. Some specific provisions in the rule include:
- Raising the administrative costs and profits ceiling under the risk corridor formula by 2%.
- Providing information on how to include ICD-10 costs under the medical loss ratio (MLR).
- Requiring qualified health plans (QHP) on the ACA Marketplace to have a more efficient and effective method for enrollees to acquire medications not covered on the plan. This specifically applies to enrollees on a course of treatment in which absence of the medication would substantially impact the individual’s life and health.
- Requiring insurers to annually report plan changes to beneficiaries.
- Beginning in 2016, Marketplaces will have to display quality data on all plans for public viewing. The data will be based on a five-star system and enrollee satisfaction surveys.
- Enumerating state requirements that may prohibit Navigators or other assistors from performing their roles. For example, Navigators may go door-to-door for enrollment assistance and outreach. They may not, however, provide gifts to entice enrollment.
- Delaying the “employee choice” option in the small business health options program (SHOP) to 2016.
The final rule is largely unchanged from the proposed version. An FAQ addressing market reforms and Marketplace standards can also be accessed here.