Insurance Market Reform

This proposed rule provides guidance on the annual fee that certain U.S. health insurers will be required to pay starting in 2014. It also clarifies the types of entities that are exempt from the fee, including self-insured employers, government entities, and certain nonprofit corporations and voluntary employees’ beneficiary associations (VEBAs).

This final rule released by HHS provides further detail on risk adjustment, reinsurance and risk corridors programs; cost-sharing reductions; user fees for federally facilitated exchanges; advance payments of the premium tax credit; the federally facilitated Small Business Health Option Program; and the medical loss ratio program.

In this FAQ on states’ involvement in plan management activities, HHS establishes that states can evaluate whether health plans and issuers meet certification standards and conduct other specified plan management activities without submitting a Blueprint.

HHS released its final rule on insurance market rules and rate view. This rule establishes an age-rating band of 3-to-1 for adults, which means that the rates for older adults cannot be higher than three times the rate being charged to younger adults, and HHS states it does not have the authority to phase-in this rating band. It also details the catastrophic plan available to younger adults and establishes the protections for individuals with pre-existing conditions.

The Centers for Medicare and Medicaid Services (CMS) released proposed rules explaining the ACA’s shared responsibility provision and the process for determining eligibility for and granting certificates of exemption from the shared provision.