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February 2013 St@teside

February's Rules and Guidance Releases

Several new Affordable Care Act-related rules were released by the U.S. Department of Health and Human Services (HHS) in February. Below is an overview of those releases, including links to the federal documents and fact sheets.
On February 20, HHS released the final rule on essential health benefits (EHB), actuarial value, and accreditation of qualified health plans. While the final rule does not present significant changes from the proposed rule, it does finalize the state benchmark approach for defining EHB in 2014 and 2015. It also sets forth limits on cost-sharing, allows for a slight leeway – plus or minus 2 percent – in the actuarial value of the metal level requirements, and finalizes the drug coverage requirements in the exchange. The final rule can be viewed here, and companion fact sheet can be viewed here.
HHS also released its final rule on insurance market rules and rate view on February 22. This rule establishes an age-rating band of 3-to-1 for adults, which means that the rates for older adults cannot be higher than three times the rate being charged to younger adults, and HHS states it does not have the authority to phase-in this rating band. It also details the catastrophic plan available to younger adults and establishes the protections for individuals with pre-existing conditions. The final rule is available here along with the corresponding fact sheet.