Bookmark and Share

March 2013 St@teside

New Federal Affordable Care Act Rules and Regulations Released

Over the past month, multiple federal agencies have issued proposed and final rules in the following areas: Health Insurance Providers Fee, Notice of Benefit and Payment Parameters for 2014, and the Multi-State Plan Program (MSPP).
The Internal Revenue Service (IRS) issued proposed rules on the Health Insurance Providers Fee, the annual fee that certain U.S. health insurers will be required to pay starting in 2014. The ACA established this fee as a mechanism to offset the costs of providing health care to uninsured individuals. The rule defines those entities that would be subject to the law, which include health insurance companies, health maintenance organizations, insurers providing health insurance under Medicare Advantage, Medicare Part D or Medicaid, and non-fully insured multiple employer welfare arrangements (MEWAs). These entities are only subject to the fee if they make more than $25 million on U.S. health insurance premiums. It further specifies additional entities that are exempt from the fee, which include self-insured employers, government entities, and certain nonprofit corporations and voluntary employees’ beneficiary associations (VEBAs). Comments on this rule are due by June 3, 2013.
The Department of Health and Human Services (HHS) also released its final rule on Notice of Benefit and Payment Parameters for 2014. This rule provides detail on standards and provisions related to:
  • Permanent risk adjustment, transitional reinsurance, and temporary risk corridors programs (together referred to as the premium stabilization programs)
  • Cost-sharing reductions
  • User fees for Federally-facilitated Exchanges
  • Advance payments of the premium tax credit
  • The Federally-facilitated Small Business Health Option Program (SHOP)
  • The medical loss ratio (MLR) program

HHS also released an interim rule that builds on the standards set forth in the Notice of Benefit and Payment Parameters for 2014. This document adjusts risk corridors calculations that would align the calculations with the single risk pool provision, and sets standards permitting QHP issuers to use an alternate methodology for calculating the value of cost-sharing reductions. Comments on this interim rule are due by April 30, 2013.
The Office of Personnel Management (OPM) released its final rule on the Establishment of the Multi-State Plan Program for the Affordable Insurance Exchanges, detailing how it will administer two multi-state plans (MSPs) on insurance exchanges nationwide. While the final rule has not changed substantially from the proposed rule, it does finalize the provision giving MSP issuers the choice to either offer coverage that meets the standards set by the state benchmark plans or those of OPM’s benchmark plans.