Resources from the Federal Government

On June 28, the Departments of the Treasury, Labor, and Health and Human Services issued the final rules on the ACA requirements that health plans cover contraceptives for women with no cost-sharing. For employees of religious non-profits, insurers and third-party administrators will be required to provide contraceptives to employees. The final rule also provides further clarification on exemption of houses of worship from this requirement.

This rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children’s Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and finalizes requirements “alternative benefit plans” to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored for exchanges. A fact sheet is available.

This proposed rule sets forth financial integrity and oversight standards with respect to health insurance exchanges, qualified health plan issuers in federally-facilitated exchanges, and states with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers.

The Department of Health and Human Services (HHS) issued the final regulation explaining the eligibility rules for receiving an exemption from the individual shared responsibility provision through a health exchange, as well as two subcategories of exemptions that will be available through the tax filing process. HHS’s final regulation includes rules that will ease implementation and help to ensure that the shared responsibility payment obligation applies only to the limited group of taxpayers who have ready access to affordable coverage but choose to spend a substantial period of time uninsured.

This report outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under ACA. The coverage offered through exchanges is discussed, and it provides detail on how individuals will qualify for federal tax credits. The report concludes with a discussion of how exchanges will interact with selected other ACA provisions.

This final rule issued by HHS amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents. It also confirms that implementation of employee choice in the federal SHOP exchange will be delayed until 2015. 

The ACA and the Department of Health and Human Services (HHS) regulations require states and American Health Benefit Exchanges (exchanges) to carry out a number of key functions, for which state responsibilities vary by exchange type. Despite some challenges, the seven selected states in GAO’s review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline of October 1, 2013

The Department of Treasury, Department of Labor, and Department of Health and Human Services issued a joint final rule on employment-based, nondiscriminatory wellness programs. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination

With changes to Medicaid eligibility going into effect in January 2014, CMS has issued a letter detailing five targeted enrollment strategies that can help states with the transition to their new eligibility and enrollment systems.