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July/August 2013 St@teside

Federal Regulation Releases

With October 1 fast-approaching, the federal government continues to push out rules and guidance. The most recent round of releases addresses a wide-range of issues, including contraceptive coverage, consumer assistance programs, minimum essential coverage, Medicaid and exchange operations, and enrollee satisfaction data collection.
On June 28, the Departments of the Treasury, Labor, and Health and Human Services issued the final rules on the ACA requirements that health plans cover contraceptives for women with no cost-sharing. Insurers and third-party administrators will be required to provide contraceptives to employees of religious non-profits. The final rule also provides further clarification on exemption of houses of worship from this requirement. Two fact sheets are available here and here
The Department of Health and Human Services (HHS) also released its final rule on minimum essential coverage. It finalized the individual mandate provision under which individuals will have to pay a fine if they do not obtain minimum essential health insurance coverage once the full ACA goes into effect. However, it also includes provisions allowing individuals to be considered for exemption from the individual mandate penalty if they are in a state that did not opt for Medicaid expansion. A fact sheet providing a more detailed summary of the final rule is available.
This final rule provides standards for federally-funded navigator programs operating in federally facilitated and state partnership exchanges, federally-funded in-person assisters, and certified application counselors (CAC). All exchanges are required to have navigators and CACs, while the requirement to have assisters varies by exchange model. The rule includes standards related to conflict of interest, training and certification, accessibility, and SHOP-only navigators.
This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance. However, it deferred certain provisions of the proposed rule to future rule-making, including exchange appeals.
On Friday, July 28, the Centers for Medicare & Medicaid Service (CMS) posted Marketplace Experience and QHP Experience Enrollee Satisfaction Surveys. The survey Paperwork Reduction Act (PRA) packages are available for public comment through August 27.  The actual survey instruments can be found under CMS form number CMS-10488 here