Tag Archives: insurance exchanges

CMS Finalizes 2017 Requirements for ACA Marketplace Plans

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 … Continue Reading

FTC/DOJ Workshop on Health Care Competition (Feb. 24).

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 … Continue Reading

Upcoming House Hearings to Address ACA Implementation, Accelerating Medical Innovation

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 panel … Continue Reading

CMS Extends “Hardship Exemptions” Policy for Health Insurance Purchasers

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 line” … 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 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

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

Congressional Hearings Focus on HealthCare.gov Enrollment, Other Policy Issues

Congressional committees continue to focus on the experience of consumers and insurers since the HealthCare.gov 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 … 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 Requests Comments on ACA Exchange Health Plan Quality Management

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 safety, … 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

Congressional Health Policy Hearings

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 … Continue Reading

Final Blueprint on Approval of State-based and State Partnership Affordable Insurance Exchanges

CMS has released its final “Exchange Blueprint” for states to use to demonstrate how their Affordable Insurance Exchanges under the ACA will meet all applicable legal and operational requirements. Separate criteria are set forth depending on whether the state operates state-based Exchange or a federally-facilitated Exchange.… 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

Accreditation Entities for ACA Qualified Health Plans

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 Assurance … Continue Reading

HHS Corrects ACA Affordable Insurance Exchanges Rule, Issues Guidance for States.

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 … Continue Reading

HHS Risk Adjustment Bulletin

HHS is requesting comments on a May 1, 2012 “Bulletin on the Risk Adjustment Program.” The draft document sets forth HHS’s intended approach to implementing health insurance risk adjustment when HHS is operating the risk adjustment function on behalf of a state (both inside and outside of the ACA Affordable Insurance Exchanges). HHS expects to … Continue Reading

Ways & Means Bill Would Recapture Additional ACA Subsidy Overpayments.

As part of efforts to meet its budget targets, the House Ways and Means Committee approved a bill on April 18, 2012 that would require all ACA health insurance exchange subsidy overpayments to be repaid in full, effective for taxable years ending after December 31, 2013. Under current law, liability for return of subsidy overpayments … Continue Reading

Obama Administration Issues Additional ACA Insurance Reform Rules

The Obama Administration has recently published additional regulations addressing various Affordable Care Act (ACA) insurance reforms, including: A CMS final rule establishing requirements for student health insurance policies offered by college and universities. The rule clarifies that such student policies are subject to certain ACA consumer protections, including a prohibition on lifetime dollar caps on … Continue Reading

IOM Issues ACA Essential Health Benefits Recommendations

Under the ACA, certain insurance plans, including those participating in new purchasing exchanges, must cover, at a minimum, a package of items and services that the Secretary has defined as essential. The Institute of Medicine (IOM) has released recommendations to HHS on a process to define what benefits should be included in the “essential health benefits” … Continue Reading

HHS Extends Comment Period For Two ACA Insurance Rules

HHS is extending until October 31, 2011 the comment period on two proposed rules published July 15, 2011 to implement provisions of the Affordable Care Act. The first rule would implement the ACA’s “Affordable Insurance Exchanges,” which are state-based health insurance markets for individuals and small employers. The second proposed rule would implement standards for states … Continue Reading

Obama Administration Issues Rules on ACA Insurance Exchanges

On August 12, 2011, the Obama Administration made a series of announcements related to implement of Affordable Insurance Exchanges (Exchanges) under the Affordable Care Act (ACA). The Exchanges, which will become operational by January 1, 2014, are designed to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options on … Continue Reading