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September 2013 St@teside

Obama Administration Releases Three Finalized Affordable Care Act Rules

Within the last month, the federal government has continued to update guidance and finalize rules related to the implementation of the Affordable Care Act. Below you can find overviews of the most recently released rules, in addition to links to the rules and fact sheets.
On August 30, the Internal Revenue Service released the final rule requiring individuals to acquire minimum essential coverage (MEC) or pay a tax penalty, which is otherwise known as the individual mandate. The final rule does not substantially differ from the proposed rule. It provides further clarification on what coverage is considered MEC and who is exempt from the having to maintain MEC. One provision that does mark a significant change from the proposed rule prohibits short-term limited duration coverage, coverage that cannot be effective for twelve months or more, from being considered MEC. Thus, those with short-term limited duration coverage will be subject to the tax penalty. A summary is available here.
This final rule by the Department of Health and Human Services (HHS) finalizes provisions necessary for successful marketplace operations during open enrollment. The regulations include guidance on a wide-range of issues listed below. A summary of the final rule can be viewed here. CCIIO has also published afact sheet.
  • Risk corridors: It defines when plans that have not been certified as qualified health plans by the exchange are subject to the risk corridor.
  • Eligibility and employer appeals: A paper-based appeals process will be allowed for the first year of Exchange operations in order to give states some flexibility as they continue to complete their systems builds. For more information on the appeals process, view this article on the State Network’s Individual Appeals Webinar.
  • Premium payment processes for the unbanked: Insurers must accept pre-paid debit cards, money orders, cashier’s checks, paper checks, and electronic funds transfers.
  • SHOP: The final rule allows states to run SHOP-only marketplaces.
  • Geographic rating: When setting geographic ratings, insurers must use the address of the primary subscriber, as opposed to the dependents.
  • Agents and brokers: Most notably, the final rule establishes requirements for the information that web-brokers must display on their websites and the verification of agents and brokers who are using web-brokers’ websites for enrolling individuals in a Federally-Facilitated Marketplace (FFM).
The final rule reducing Medicaid disproportionate share hospital (DSH) payments had few changes from the proposed rule. It cuts $500 million in fiscal 2014 and $600 million in fiscal 2015 allotments. The rule also defines the five factors that will be considered to generate a state-specific reduction allotment amount and establishes additional reporting requirements for the new DSH methodology. A CMS fact sheet is available.