After facing sharp criticism on Health Insurance Exchange implementation by the U.S. Senate Finance Committee on February 14, 2013, the U.S. Department of Health and Human Services (HHS) has been actively issuing final and proposed Affordable Care Act rules over the past two weeks.
These final and proposed rules include:
- Final health insurance issuer standards for essential health benefits (EHBs) that health insurance issuers must cover both inside and outside of the exchanges, now rebranded as “Health Insurance Marketplaces.” Additionally, the rule sets forth a timeline for when issuers offering coverage in a Federal Exchange/Marketplace must become accredited. See the Duane Morris Alert on this final rule.
- Changes to HHS rate regulation and a reaffirmation of other market reforms, including maintaining the implementation of the rules regarding age rating bands.
- Final standards on the advance payments of the premium tax credit; cost-sharing reductions; medical loss ratio (MLR); the Small Business Health Options Program (SHOP); and the 3R’s – the permanent risk adjustment, transitional reinsurance and temporary risk corridors programs. This final rule expands on the information set forth in the proposed rules issued on December 7, 2012.
- Proposed transitional policy for SHOP exchanges, which will no longer be required to offer the employee choice model and premium aggregation until Jan. 1, 2015. State-based exchanges have the option to offer the programs in 2014, but federally-facilitated SHOP exchanges will have the one-year delay.
The Office of Personnel Management also released a final rule regarding multi-state plans.