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September 2011 St@teside

Summaries of Recent Proposed Federal Rules on the Patient Protection and Affordable Care Act (ACA)

The federal government has issued several proposed rules recently that will impact state implementation of the Patient Protection and Affordable Care Act (ACA).

HHS Proposed Rules on Exchange Implementation Requirements
Manatt Health Solutions highlights the proposed regulations that will impact state planning and implementation of exchanges. Those regulations clarify the criteria state exchanges will need to meet in order to be approved, and they introduce the concept that exchanges can be a federal-state partnership. The proposed regulations also provide more detail related to the Small Business Health Options Program (SHOP), enrollment periods and effective dates in the individual market, and the exchange establishment process and criteria. The
comment deadline has been extended to October 31, 2011.

The Center for Consumer Information and Insurance Oversight (CCIIO) provided additional information on their vision for the state-federal partnership at a recent meeting on state-based exchanges. They outlined a proposal that stipulates that a federal-state partnership technically is a federally operated exchange with defined state roles. States can operate plan management, consumer assistance, or both. The plan is further outlined here and here.

Analysis of HHS Proposed Rules on Reinsurance, Risk Corridors and Risk Adjustment
Wakely Consulting Group summarizes the recent proposed rules on reinsurance, risk-adjustment and risk-corridors. This brief also provides insight on how states should be thinking about the issues identified in the federal regulations. The comment deadline has been extended to October 31, 2011.

Overview and Analysis of Proposed Exchange, Medicaid and IRS Regulations Issued on August 17, 2011
Manatt Health Solutions analyzes proposed rules related to the Medicaid eligibility expansion, exchange eligibility determinations, and premium tax credit eligibility under the health reform law. The report provides an overview of the proposed rules and presents new insight into how those regulations will inform state implementation of health reform.
Comments are due October 31, 2011.

Each of these summaries were produced by the State Health Reform Assistance Network which  includes 10 states, and is the primary avenue through which the Robert Wood Johnson Foundation will provide technical assistance to states for implementation of health reform related to coverage over the next several years. The program focuses on helping states set up insurance exchanges, institute insurance market reforms, expand Medicaid to newly eligible populations, streamline eligibility and enrollment systems, and use data to drive decisions. The program is coordinated from Princeton University with significant support from State Coverage Initiatives (SCI), a Robert Wood Johnson Foundation program at AcademyHealth. Several leading national organizations are also providing technical assistance.