Resources from the Federal Government

The Centers for Medicare and Medicaid Services (CMS) has issued its final rule on the increased Federal Medical Assistance Percentage (FMAP) rates under the ACA. Beginning in January 2014, the federal government will cover 100 percent of the costs of newly eligible Medicaid beneficiaries through 2016, and then it will phase down to a 90 percent match rate by 2020.

The Department of Health and Human Services (HHS) has released its proposed rule regarding training and meaningful access standards for navigators and other personnel who will help individuals shop for health insurance in the new health exchanges. 

This interim rule 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. 

The ACA requires a streamlined process for determining eligibility and enrolling applicants in the state health exchanges, Medicaid, and the Children’s Health Insurance Program (CHIP) by January 1, 2014. This report assesses the states’ readiness to implement the streamlined eligibility and enrollment systems.

The Office of Personnel Management (OPM) released its final rule on 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.

HHS has issued its proposed rule for the Small Business Health Options Program (SHOP), which highlights special enrollment periods for the small-business exchanges and proposes policies for facilitating the transition for employers entering the new marketplaces. It also announced that the employee choice and premium aggregation components of SHOP will not be required until January 1, 2015, delaying them by one year.

This final rule released by HHS provides further detail on risk adjustment, reinsurance and risk corridors 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; and the medical loss ratio program.

This proposed rule provides guidance on the annual fee that certain U.S. health insurers will be required to pay starting in 2014. It also clarifies the types of entities that are exempt from the fee, including self-insured employers, government entities, and certain nonprofit corporations and voluntary employees’ beneficiary associations (VEBAs).

HHS released its final rule on insurance market rules and rate view. This rule establishes an age-rating band of 3-to-1 for adults, which means that the rates for older adults cannot be higher than three times the rate being charged to younger adults, and HHS states it does not have the authority to phase-in this rating band. It also details the catastrophic plan available to younger adults and establishes the protections for individuals with pre-existing conditions.

HHS released the final rule on essential health benefits (EHB), actuarial value, and accreditation of qualified health plans. This rule finalizes the state benchmark approach for defining EHB in 2014 and 2015. It also sets forth limits on cost-sharing, allows for a slight leeway – plus or minus 2 percent – in the actuarial value of the metal level requirements, and finalizes the drug coverage requirements in the exchange.