CMS has published its annual Notice of Benefit and Payment Parameters, which governs participation in the Affordable Care Act (ACA) Health Insurance Marketplaces for 2017.  The sweeping rule addresses protection of consumers enrolled in Marketplace plans, network adequacy, marketplace premium stabilization programs, and various other refinements to Marketplace requirements.  Major provisions of the rule include the following:
Continue Reading CMS Finalizes 2017 Requirements for ACA Marketplace Plans

On February 24, 2015, the Federal Trade Commission and the Department of Justice Antitrust Division will hold a public workshop on health care provider organization and payment model developments that may affect competition in the provision of health care services. Topics for discussion include: accountable care organizations; alternatives to traditional fee-for-service payment models; trends in

On September 9, 2014, the House Energy and Commerce Subcommittee on Health is holding a hearing entitled “21st Century Cures: Examining the Regulation of Laboratory Developed Tests.” The hearing will focus on the FDA’s recent guidance on the regulation of lab developed tests and its “impact on innovation and the practice of precision medicine.” The

CMS has provided additional guidance on its evolving hardship exemptions policy for individuals who had difficulty signing up for a qualified health plan (QHP) through an Affordable Insurance Exchange by the March 31, 2014 deadline. As previously reported, in March CMS announced it had established a “special enrollment period” for individuals who were “in

Recent Congressional hearings have addressed a number of health policy issues, including the following:

  • House Science, Space, and Technology Committee hearing entitled “ 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

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

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

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,”

Congressional committees continue to focus on the experience of consumers and insurers since the insurance portal launched on October 1, along with potential issues related to the security of personal data transmitted through the site. For instance, House hearings this week include an Oversight and Government Reform Committee hearing on “ObamaCare Implementation: The 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 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

On November 27, 2012, CMS published a notice inviting public comments regarding health plan quality management requirements for qualified health plans (QHPs) participating in Affordable Insurance Exchanges. Specifically, CMS is seeking feedback on current and potential quality measures and rating systems, quality improvement strategies and requirements, purchasing strategies to promote care redesign and patient

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

A number of recent Congressional hearings have focused on health policy issues, including the following:

  • A House Small Business Healthcare Subcommittee hearing on “Medicare’s Durable Medical Equipment Competitive Bidding Program: How Are Small Suppliers Faring?”
  • Senate Aging Committee hearings on “Implementing the Physician Payments Sunshine Act” and “Eliminating Waste and Fraud in Medicare: An Examination

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

On June 5, 2012, the Department of Health and Human Services (HHS) published a proposed rule that would 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 proposes to recognize the National Committee for Quality

The Department of Health and Human Services (HHS) has posted a notice correcting technical and typographical errors in its March 27, 2012 interim final rule implementing the new Affordable Insurance Exchanges under the ACA. The correction notice is effective May 29, 2012. HHS also has released an “Exchange Blueprint” for states to use to demonstrate