On December 1, 2010, the Department of Health and Human Services (HHS) is publishing an interim final rule with comment period implementing ACA medical loss ratio requirements. Under the rule, beginning in 2011, insurance companies in the individual and small group markets must spend at least 80% of the premium dollars they collect on
Office of Consumer Information and Insurance Oversight (OCIIO)
Federal Funding, Guidance for Medicaid Eligibility Determination/Enrollment, HIT Activities
By Debra A. McCurdy on
This post was also written by Jacqueline B. Penrod.
CMS published a proposed rule on November 8, 2010 that would provide additional federal funding for certain Medicaid eligibility determination and enrollment activities under the ACA and update regulations to reflect other Medicaid eligibility and business process changes. Specifically, Medicaid eligibility systems potentially will be eligible…
Waivers of ACA Annual Benefit Limits
By Debra A. McCurdy on
The HHS Office of Consumer Information and Insurance Oversight (OCIIO) has released subregulatory guidance on the process for health plans to apply for a waiver of restricted annual limits on the dollar value of essential health benefits if such a waiver is necessary to prevent a significant decrease in access to benefits or a significant…
Obama Administration Guidance on ACA External Review Process/Appeals
By Debra A. McCurdy on
On August 26, 2010, the Internal Revenue Service, Employee Benefits Security Administration (EBSA), and the HHS Office of Consumer Information and Insurance Oversight published a notice announcing the availability of guidance detailing interim procedures for the federal external review process and model notices both for internal claims and appeals and for external review processes under…
OCIIO Seeks Comments on State Insurance Exchanges
By Debra A. McCurdy on
On August 3, 2010, the Office of Consumer Information and Insurance Oversight (OCIIO) published a notice soliciting comments regarding ACA state insurance exchange provisions to inform future rulemaking and grant solicitations. OCIIO requests comments on number of specific questions in the following areas: state exchange planning and establishment grants; implementation timeframes and considerations; exchange operations…
ACA Pre-Existing Condition Insurance Plan Program
By Debra A. McCurdy on
The OCIIO has published an interim final rule with comment period implementing the ACA’s temporary high risk health insurance pool program. This program, which is intended to provide affordable health insurance coverage to uninsured individuals with pre-existing conditions, will continue until January 1, 2014, when health insurance exchanges are operational. Key issues addressed in…
Other Recent ACA Guidance and Reports
By Debra A. McCurdy on
The Obama Administration continues to issue guidance documents and summary information regarding the ACA, including the following:
- The OCIIO has posted “Questions and Answers on Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions.”
- CMS has issued a memo to state Medicaid directors providing guidance on provisions of the ACA
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