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May 2013 S@teside

Federal Rules and Guidance Releases

The latest round of rules and guidance released by the federal government address a variety of issues, including the roles of agents and brokers in health insurance marketplaces (exchanges), Medicaid enrollment strategies, minimum value of employer-sponsored coverage, disproportionate share hospital (DSH) payments, and medical loss ratio. 
The Internal Revenue Service (IRS) released a proposed rule on the minimum value that employer-sponsored coverage must provide in order to comply with the Affordable Care Act (ACA) and not be subject to the employer mandate penalty. It also provides additional guidance on premium tax credits. Comments on the proposed rule are due by July 2, 2013.

Computation of, and Rules Relating to, Medical Loss Ratio
The IRS also released proposed regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other health care organizations, on computing and applying the medical loss ratio as detailed in the ACA.  That provision requires carriers to apply at least 80 percent of paid premiums to health care services and up to 20 percent to administrative costs. Comments are due by August 12, 2013, and a public hearing is scheduled for September 17, 2013.

State Disproportionate Share Hospital Allotment Reductions
The Centers for Medicare and Medicaid Services (CMS) released an additional proposed rule on DSH payments. The proposed rule specifies the methodology for the annual reductions in DSH payments from fiscal year 2014 through fiscal year 2020, as required by the ACA. The rule also outlines some additional proposed DSH reporting requirements. Comments on the proposed rule are due by July 12, 2013. A fact sheet is also available here.
This Frequently Asked Questions (FAQ) released by CMS provides additional guidance on enhanced funding for Medicaid eligibility systems operation and maintenance. Under the Medicaid program, states are eligible to receive a 90 percent federal matching funds for the design and development of ACA-compliant Medicaid eligibility determination systems and a 75 percent federal matching funds for maintenance and operations. This set of FAQs provides general guidelines about what costs are eligible for enhanced funding and how CMS will work with each state to review and approve the costs that will be covered.
CCIIO released this letter further addressing the role of agents, brokers, and web-brokers in educating consumers about the Health Insurance Marketplace and insurance affordability programs. This three-part document provides a high-level overview of their roles in Federally-facilitated and State Partnership Marketplaces. It addresses common questions raised by states and other stakeholders on the role of agents and brokers in all Marketplaces – including State-based Marketplaces. It also includes process flows for both pathways.
With changes to Medicaid eligibility going into effect in January 2014, CMS has issued a letter detailing five targeted enrollment strategies that can help states with the transition to their new eligibility and enrollment systems.