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April 2012 St@teside

Summaries of Recent Final Regulations on the ACA

On March 12 and 16, 2012, the U.S. Department of Health and Human Services (HHS) issued several final and interim regulations that will impact state implementation of the Patient Protection and Affordable Care Act (ACA)—Establishment of Exchanges and Qualified Health Plans; and Exchange Standards for Employers, Medicaid Eligibility and Enrollment, and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment.

The exchange final rule includes standards for: Establishment of an Exchange; Federal Partnership Models; Eligibility for Subsidy; Verification Rules; Qualified Health Plans; Financing Options; Navigators and Brokers; and the Small Business Health Options Program (SHOP).

The Medicaid final rule includes standards for: Seamless/Coordinated Eligibility Determinations; Timeliness; Verification; Eligibility Determinations of Non-MAGI applicants; and Budget Periods.

The deadline to comment on the Medicaid and exchange interim rules are May 7 and 11, 2012, respectively.

Manatt Health Solutions has prepared an overview of the final and interim Medicaid eligibility regulation and the final and interim exchange regulation.

Wakely Consulting Group has prepared an issue brief that summarizes the final rules on reinsurance, risk corridors, and risk adjustment, highlights the changes from the proposed rules, and provides Wakely’s perspective on the implications. Previously, Wakely prepared a work plan and webinar for states officials on the decisions and actions necessary to implement the reinsurance and risk adjustment provisions of the ACA.

Each of these summaries was produced by the State Health Reform Assistance Network which includes 10 states, and is the primary avenue through which the Robert Wood Johnson Foundation is providing technical assistance to states for implementation of health reform related to coverage over the next several years.