Insurance Market Reform

This paper explores several strategies states could implement beyond federal requirements, using policy decisions in 11 states—Alabama, Colorado, Illinois, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island, and Virginia—to illustrate the choices being made to protect against and mitigate the effects of both “rate shock” and adverse selection in the individual market . The findings indicate that study states had mixed approaches to mitigating rate shock and adverse selection, with some taking steps beyond the required federal measures but with other policy options left unexplored. Minimizing the impact of adverse selection—both against the overall insurance market and the exchanges—will require strong monitoring and oversight.

This final rule establishes the annual fee that will be imposed on health insurers, HMOS, self-insured Multiple Employment Welfare Arrangements (MEWAs), and entities that provide coverage under Medicare Parts C and D and Medicaid beginning in 2014. This health insurance tax is intended to help fund the insurance coverage expansion under the ACA.

This proposed rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also proposes additional standards with respect to composite rating, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, etc.

This notice with comment describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.

This final rule maintains the protections of the Mental Health Parity Act of 1996 and adds new protections. The rule requires insurance companies to offer mental health and substance-use disorder benefits that are comparable to their medical and surgical benefits. However, the final rule does not require employers to offer mental health coverage.