Tag Archives: Essential Health Benefits

CMS Adopts 2019 ACA Health Plan Policies

CMS has released its final rule updating policies applying to qualified health plans (QHPs) offered on Affordable Care Act (ACA) Exchanges for 2019.  In the final rule, CMS stresses its goal of providing states greater flexibility and control over their insurance markets, particularly in the areas of: selection of essential health benefits benchmark plans; the … Continue Reading

Interim Final Rules Expand Contraceptive Coverage Exemption Based on Religious/Moral Beliefs

The Trump Administration has issued interim final rules to make it easier for employers and health insurance plans to qualify for an exemption from ACA rules mandating coverage of contraceptive services without cost sharing on the basis of religious or moral objections. The extent to which group health plans must cover contraceptive services in cases … Continue Reading

Obama Administration Finalizes Regulations on ACA Coverage of Preventive Services, Including Contraceptive Services

The Obama Administration published final regulations on July 14, 2015 that implement Affordable Care Act requirements regarding coverage without cost sharing of certain preventive services, including contraceptive services. The regulations, jointly issued by the Departments of Health, Labor, and Treasury, finalize three earlier rulemakings:… Continue Reading

HHS Revises ACA Contraception Coverage Requirements

The Obama Administration has issued two regulations addressing coverage of contraceptive services under QHPs in response to recent court rulings (in particular the Supreme Court ruling in Burwell v. Hobby Lobby Stores, Inc.) addressing certain religious objections to such coverage. First, an interim final rule provides an additional pathway for nonprofit organizations eligible for a … Continue Reading

CMS Issues Final Medicaid Eligibility/Enrollment Rule under the ACA

On July 15, 2013, CMS published a final rule to implement various provisions of the ACA related to Medicaid and CHIP essential health benefits, enrollment, and eligibility rules. Among other things, the rule: finalizes new Medicaid eligibility provisions; streamlines existing Medicaid eligibility, cost-sharing, and premium rules; amends requirements for benchmark and benchmark-equivalent benefit packages to … Continue Reading

HHS Issues Rules to Implement ACA Essential Health Benefit Framework

On February 25, 2013, the Department of Health and Human Services (HHS) published a final rule to implement key provisions of the Affordable Care Act (ACA) related to essential health benefits, (EHBs), calculation of actuarial value (AV), and accreditation standards. By way of background, the ACA requires health plans offered in the individual and small … Continue Reading

CMS, IRS Proposed ACA “Shared Responsibility” Payment/Exemptions Rules

On February 1, 2013, CMS and the Internal Revenue Service (IRS) published two proposed regulations to address the requirement to maintain minimum essential coverage under the Affordable Care Act (ACA). By way of background, the ACA requires every individual to have basic health insurance coverage (known as minimum essential coverage), qualify for an exemption, or … Continue Reading

CMS Proposes Changes to Medicaid Eligibility, Benefits, and Appeals Rules

On January 22, 2013, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule designed to provide states with additional flexibility in administering their Medicaid, Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) Exchange programs. Among many other things, the rule would enhance the ability of states to coordinate eligibility determinations, appeals … Continue Reading

HHS Proposes Standards for Essential Health Benefits, Actuarial Value, and Accreditation under the ACA

The Department of Health and Human Services (HHS) has published a major proposed rule that would, among other things, implement key provisions of the Affordable Care Act (ACA) related to essential health benefits (EHBs), calculation of actuarial value (AV), and accreditation standards. By way of background, the ACA requires health plans offered in the individual … Continue Reading

Obama Re-election Sets Stage for Full ACA Implementation

True to predictions that HHS regulatory activities to implement the ACA would accelerate after last week’s national elections, CMS has sent several ACA implementation rules to the Office of Management and Budget for final regulatory clearance. Among other things, the Administration is seeking clearance for the highly-anticipated proposed rule establishing the essential health benefits standards … Continue Reading

HHS Final Rule on Accreditation Entities, Data Collection Requirements for ACA Qualified Health Plans

On June 20, 2012, HHS is publishing a final rule to implement the first phase of a process to recognize accrediting entities that will certify qualified health plans for participation in ACA Affordable Insurance Exchanges. In phase one, HHS is recognizing the National Committee for Quality Assurance and URAC as accrediting entities on an interim … Continue Reading