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
Insurance
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
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CMS Releases Standard Consumer Notices under ACA Grandfathering/Transitional Policy
CMS has posted the standard notice that insurers issuers must provide to policyholders if they intend to allow individuals to continuing existing health insurance coverage in 2014 under the Administration’s “transitional policy” (even if the plan does not meet all ACA insurance standards).
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…
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…
HHS Corrects March 2013 ACA Benefit, Payment Parameter Rules
HHS has corrected technical and typographical errors in the March 11, 2013 HHS final rule establishing ACA health insurance benefit and payment parameters for 2014. The correcting amendment is effective November 6, 2013.
Obama Administration Publishes Final Mental Health/Substance Abuse Parity Rule
On November 13, 2013, the Departments of Health and Human Services (HHS), Labor, and the Treasury published a joint final rule implementing the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The MHPAEA requires group health insurance plans to provide parity between mental health or substance use…
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…
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…
GAO Ties Medicare Supplemental Coverage to Higher Health Spending
This post was written by Nancy Sheliga.
At the request of Senate Republican policymakers seeking a better understanding regarding the impact of supplemental coverage on overall Medicare spending, the Government Accountability Office (GAO) recently compared the health care expenditures of beneficiaries with only traditional fee-for-service (FFS) Medicare coverage to those of beneficiaries who have…
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…
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…
House Approves Bill to Require Verification of ACA Individual Subsidy Eligibility
On September 12, 2013, the House of Representatives approved H.R. 2775, the “No Subsidies Without Verification Act,” on a vote of 235 to 191. The bill would prevent ACA health insurance premium tax credits or cost-sharing reductions from being provided until the HHS OIG certifies that an effective program is in place to…
July Health Policy Hearings
Recent Congressional hearings have addressed the following health policy issues:
- The House Energy and Commerce Committee has held hearings on Medicaid reform, implementation of the ACA, and reform of drug compounding regulations. An August 1 hearing entitled “PPACA Pulse Check” will feature testimony by CMS Administrator Marilyn Tavenner.
- The Senate Finance Committee held two hearings
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Obama Administration Announces Delay in Employer ACA “Shared Responsibility” Payments, Reporting Requirements until 2015
On July 2, 2013, the Obama Administration announced (via a web posting) that it is delaying the Affordable Care Act’s (ACA) employer “shared responsibility” payment obligation (commonly referred to as the “employer mandate”) until January 1, 2015. The “shared responsibility” payment requirement, originally scheduled to begin January 1, 2014, requires certain employers with 50…
CMS Proposes ACA Exchange/Qualified Health Plan Financial Integrity and Oversight Standards
On June 19, 2013, CMS published a proposed rule that sets forth financial integrity and oversight standards for participants in ACA Affordable Insurance Exchanges/Marketplaces. Among other things, the rule addresses: oversight of premium stabilization programs; oversight provisions related to state Exchanges, such as those pertaining to financial integrity and maintenance of records; standards for…
Obama Administration Credits ACA Rules with $3.9 Billion in Insurance Premium Savings, Rebates for 2012
On June 20, 2013, HHS announced that health insurance consumers will save a total of $3.9 billion under the ACA’s Medical Loss Ratio (MLR) rule in 2012, including $3.4 billion in the form of reduced premiums and $504 million in rebates rules. Under the ACA MLR provision, insurers must spend at least 80% of total…
CMS Gears Up for ACA Health Insurance Marketplace/Exchange Launch
The Obama Administration is stepping up its outreach efforts in preparation for consumer enrollment for health coverage through the ACA Health Insurance Marketplace/Exchanges later this year. The Administration has re-focused its HealthCare.gov website to provide consumer information; by October, consumers will be able to create accounts, complete an online application, and shop for qualified health…
CMS Sets Provider Payment Rates Under the ACA Pre-Existing Condition Insurance Plan Program
The ACA’s Pre-Existing Condition Insurance Plan (PCIP) program is a temporary high-risk health insurance program for uninsured individuals who have been denied health insurance because of a pre-existing condition. While the PCIP was intended to serve as a “bridge” until Affordable Insurance Exchanges are operational in 2014, the Department of Health and Human Services (HHS)…
DOL Releases Insurance Exchange Notice Guidance and Model Notices
On May 8, the Department of Labor (DOL) issued guidance regarding the ACA requirement that employers provide notice to employees describing the coverage options available under Health Insurance Marketplaces/Exchanges. DOL also has released model notices to employees of coverage options. A Reed Smith summary of DOL’s guidance is available here.