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March 2014 St@teside

Federal Guidance Updates

As we move towards March 31 and the end of the plan year 2014 open enrollment period, the federal government has released some important guidance and rules on policy issues. Included are:

  • On February 27, CMS announced that individuals who were unable to purchase a qualified health plan (QHP) due to technical issues with their state’s exchange and its enrollment process are eligible to receive the advanced premium tax credits (APTC) and cost sharing reductions (CSR) that had been reserved for individuals who purchased a QHP through their state’s exchange website. In order to receive the APTC and CSR, an individual must have submitted an application for coverage during the open enrollment period. The announcement provides subsidies to individuals who both opted to forgo coverage and who chose to purchase an off-exchange plan. As long as the purchased off-exchange plan meets the minimum requirements of the ACA, the individual is eligible to receive the APTC and CSR. People who purchased an off-exchange plan will also have a special enrollment period allowing them to change QHPs to one offered on the exchange moving forward.
  • On March 5, CMS announced a two-year extension to the transition policy which allows non-grandfathered plans to continue for renewal. The original policy allowed these plans to be renewed through 2014; the new extension means that they can remain through 2016, if states elect to allow for them in their insurance markets.
  • On March 7, CMS released a final rule on the Basic Health Program (BHP). This rule creates a framework for the BHP, which is designed as an alternative coverage option for individuals with incomes just above Medicaid eligibility and at the lowest-level for purchasing insurance on the exchanges. The goal of the BHP is to provide a coverage option that will minimize churn between Medicaid and a QHP, and that will allow individuals in the lower income levels to find affordable insurance coverage. The final rule provides funding for states starting in 2015, although most states are not in a position to design a BHP program until plan year 2016, with the exception of Minnesota, which has been working with CMS and plans to implement a BHP option in 2015.
  • On March 14, the administration released an interim final rule that requires qualified health plans and stand-alone dental plans sold on the exchanges to accept premium and cost-sharing payments from third party payors, including Ryan White HIV/AIDS programs and Indian organizations.
  • On March 14, the administration released guidance extending the non-discrimination requirement for insurers who offer family coverage on the insurance exchanges to legally married same-sex couples.
  • On March 14, the administration announced that the Pre-Existing Condition Insurance Plan (PCIP) high-risk pools will be extended for another month, through April 30, 2014. This extension is available for current enrollees in the PCIP who have not been able to purchase insurance through the exchanges. They will be able to purchase one additional month of coverage in the PCIP to avoid gaps in coverage.

More information about these announcements can be found on the Health Affairs blog, in two posts (here and here) authored by Timothy Jost.