Tag Archives: Affordable Insurance Exchange

Obama Administration Continues to Update ACA Insurance Exchange and Health Plan Regulations

The Administration has issued numerous regulations recently that make additional changes to operational policies, payment provisions, and other standards applicable to health plans and Health Insurance Exchanges (also called Marketplaces) under the Affordable Care Act (ACA). Highlights include the following:… Continue Reading

CMS Releases Subregulatory Guidance on ACA Insurance Coverage, Exchange Issues

Recent CMS subregulatory guidance and related announcements regarding ACA insurance coverage and insurance exchange issues include the following: On March 14, 2014, CMS released its final “2015 Letter to Issuers in the Federally-facilitated Marketplaces,” which provides operational and technical guidance to issuers seeking to offer qualified health plans (QHPs) in a federally-facilitated Marketplace and/or SHOP. CMS is … Continue Reading

CMS Rule Requires Qualified Health Plans to Accept Certain Third-Party Premium Payments

Today CMS published an interim final rule with comment period that requires qualified health plan (QHP) issuers to accept premium and cost-sharing payments made on behalf of enrollees by the Ryan White HIV/AIDS Program, Indian tribes and organizations, and other federal and state government programs that provide premium and cost sharing support. This rulemaking was prompted by … Continue Reading

CMS to Allow Retroactive ACA Insurance Subsidies for Certain Non-Marketplace Plans

CMS has announced that in light of persistent problems individuals have had enrolling in qualified health plans (QHPs) through some state-run Marketplaces, it will now allow individuals to access premium tax credits and cost-sharing reductions on a retroactive basis in certain circumstances. Specifically, in guidance dated February 27, 2014, CMS states that if a Marketplace … Continue Reading

Congressional Health Policy Hearings

Recent Congressional hearings have addressed a number of health policy issues, including the following: House Science, Space, and Technology Committee hearing entitled “Healthcare.gov: Consequences of Stolen Identity”; A House Energy and Commerce Oversight Subcommittee hearing on implementation of the ACA, including a discussion of insurance exchange issues; Two House Oversight and Government Reform Committee hearings … Continue Reading

CMS Proposes 2015 Funding Methodology for ACA Basic Health Program

CMS has published its proposed methodology and data sources necessary to determine federal payment amounts made to states that elect to establish a Basic Health Program (BHP) under the Affordable Care Act (ACA) to offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through Affordable Insurance Exchanges. The BHP, which will be … Continue Reading

CMS Issues Formally Updates 2014 Health Exchange Enrollment Deadlines

CMS has published an interim final rule with comment period that sets a December 23, 2013 deadline for individuals to select a qualified health plan through an Exchange for an effective coverage date of January 1, 2014, to conform to a previously-announced policy. The prior regulation imposed a December 15, 2013 deadline. State Exchanges may select … Continue Reading

Hardship Exemption for Individuals with Cancelled Insurance Policies

The Obama Administration has announced a “hardship” exemption for certain individuals who have been notified that their individual health insurance policies have been cancelled and will not be renewed. In such cases, if the individual believes that the plan options available in the ACA Health Insurance Marketplace/Exchange are more expensive then the cancelled health insurance policy, … Continue Reading

CMS Proposed Rule on ACA Benefit and Payment Parameters for 2015

On December 2, 2013, CMS published a proposed rule that would establish 2015 payment parameters and oversight provisions for federally-facilitated Health Insurance Exchanges under the ACA. The rule specifically addresses 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 for composite rating, … Continue Reading

Congressional Hearings Examine ACA Insurance Developments and Other Health Policies

Recent Congressional hearings on health policy issues have included the following, among others: A House Small Business Committee hearing focused on the ACA’s Small Business Health Options Program. A House Ways and Means Health Subcommittee hearing reviewed “the Challenges of the Affordable Care Act,” focusing on “immediate and long-term challenges Americans face in finding affordable, quality health coverage … Continue Reading

House Approves “Keep Your Health Plan Act”

On November 15, 2013, the House of Representatives voted 261 to 157 to approve H.R. 3350, the “Keep Your Health Plan Act,” which would allow health plans available on the individual market as of January 1, 2013 to continue in 2014 without meeting new ACA plan standards. Continued enrollment in such a grandfathered policy would … Continue Reading

Congressional Panels Continue Focus on ACA Insurance Enrollment, Security, and Cost Issues, and Other Health Policy Topics

Congress continues to examine issues associated with enrollment in qualified health plans under Healthcare.gov.  For instance: The House Science, Space, and Technology Committee held a hearing entitled “Is My Data on Healthcare.gov Secure?” The Senate Small Business and Entrepreneurship Committee focused on “Affordable Care Act Implementation: Examining How to Achieve a Successful Rollout of the … Continue Reading

CMS Seeks Input on Quality Ratings for ACA Exchange Plans

On November 19, 2013, CMS published a notice seeking comments on its proposed Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an ACA Affordable Insurance Exchange. Specifically, CMS lists proposed QRS quality measures that QHP issuers would be required to collect and report, and describes the hierarchical structure of the … Continue Reading

HHS Allows Grandfathering of Certain Insurance Policies Cancelled under ACA Rules

President Obama announced on November 14, 2013 that HHS has adopted an administrative policy to allow insurers to continue to offer certain health insurance policies scheduled to be cancelled effective January 1, 2014 because of more stringent coverage requirements under the ACA. In short, under the“transitional” policy outlined in a letter to state insurance commissioners, health … Continue Reading

Obama Administration Releases Initial Health Insurance Marketplace Enrollment Numbers

On November 13, 2013, HHS issued its first report on ACA Health Insurance Marketplace/Exchange enrollment statistics. According to the Administration, 106,185 individuals have selected health plans during the first 33 days of the open enrollment period (October 1 through November 2, 2013), although this figure also includes individuals who have not yet purchased a policy … Continue Reading

House Schedules Vote on “Keep Your Health Plan Act”

The House of Representatives is scheduled to take up legislation on November 15, 2013 that responds to growing attention to policy cancellations in the individual health insurance market linked to more stringent coverage requirements going into effect in 2014 under the ACA. Specifically, the House will consider H.R. 3350, the “Keep Your Health Plan Act,” … Continue Reading

Obama Administration Aligns Health Exchange Enrollment Deadline and “Shared Responsibility” Penalty Trigger

CMS recently issued guidance to ensure that individuals who purchase insurance through the ACA Marketplace/Insurance Exchange near the end of the initial open enrollment period are not subject to a penalty for a break in insurance coverage. By way of background, beginning in 2014, the ACA requires every individual to maintain health coverage (known as … Continue Reading

Congressional Hearings Focus on Rocky HealthCare.gov Rollout

Several House committees have held hearings to grill HHS officials and their contractors on various problems consumers and insurers have encountered during the first month of the HealthCare.gov insurance portal’s operation. On October 24, the House Energy and Commerce Committee held a hearing entitled on “PPACA (Patient Protection and Affordable Care Act) Implementation Failures: Didn’t … Continue Reading

CMS Finalizes ACA Exchange Program Integrity & Financial Oversight Standards

On October 30, 2013, CMS published a final rule that sets forth financial integrity and oversight standards for participants in Affordable Care Act (ACA) Insurance Exchanges/Marketplaces. According to a CMS press release, these policies largely are unchanged from previous proposed rules and guidance documents. Among other things, the rule addresses: oversight of state-operated risk adjustment … Continue Reading

ACA Health Insurance Marketplace Opens for Business to Mixed Reviews

On October 1, 2013, the Affordable Care Act’s (ACA) long-awaited Health Insurance Marketplace was launched at www.healthcare.gov. As has been widely reported, many consumers experienced technical problems using the federal site to enroll in qualified health plans, which the Administration has largely chalked up to greater-than-expected demand and site capacity issues that are being addressed … Continue Reading

HHS Proposes ACA Basic Health Program Regulations

On September 25, 2013, HHS published a proposed rule that would establish the Basic Health Program, as required by section 1331 of the ACA. The Basic Health Program would provide states with the flexibility to establish a health benefits coverage program for low-income individuals who would otherwise be eligible to purchase coverage through the state’s … Continue Reading

Obama Administration Warns Consumers about Potential “Obamacare” Fraud

The OIG has issued a consumer alert warning consumers about potential fraud related to enrollment in ACA Health Insurance Marketplaces. Among other things, the OIG cautions individuals about people asking for money to enroll the individual in the Marketplace or “Obamacare”; high-pressure solicitations; or requests for personal information.  Likewise, HHS, the Department of Justice, and … Continue Reading