Resources from the Federal Government

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Contraceptive Coverage Final Regulations

Aug 2013

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. For employees of religious non-profits, insurers and third-party administrators will be required to provide contraceptives to employees. The final rule also provides further clarification on exemption of houses of worship from this requirement.


Final Rule on Premium Tax Credit, Medicaid and CHIP Eligibility Determinations

Jul 2013

This rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children’s Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and finalizes requirements “alternative benefit plans” to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored for exchanges. A fact sheet is available.


Proposed Rule on Program Integrity Guidelines for the Exchange and Premium Stabilization Programs

Jul 2013

This proposed rule sets forth financial integrity and oversight standards with respect to health insurance exchanges, qualified health plan issuers in federally-facilitated exchanges, and states with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers.


Final Rule: Eligibility for Exemptions and Minimum Essential Coverage Provisions

Jul 2013

The Department of Health and Human Services (HHS) issued the final regulation explaining the eligibility rules for receiving an exemption from the individual shared responsibility provision through a health exchange, as well as two subcategories of exemptions that will be available through the tax filing process. HHS’s final regulation includes rules that will ease implementation and help to ensure that the shared responsibility payment obligation applies only to the limited group of taxpayers who have ready access to affordable coverage but choose to spend a substantial period of time uninsured.


Health Insurance Exchanges Under the Patient Protection and Affordable Care Act (ACA)

Jun 2013

This report outlines the required minimum functions of exchanges, and explains how exchanges are expected to be established and administered under ACA. The coverage offered through exchanges is discussed, and it provides detail on how individuals will qualify for federal tax credits. The report concludes with a discussion of how exchanges will interact with selected other ACA provisions.


Small Business Heath Options Program Final Rule

Jun 2013

This final rule issued by HHS amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents. It also confirms that implementation of employee choice in the federal SHOP exchange will be delayed until 2015. 


Seven States’ Actions to Establish Exchanges under the Patient Protection and Affordable Care Act

Jun 2013

The ACA and the Department of Health and Human Services (HHS) regulations require states and American Health Benefit Exchanges (exchanges) to carry out a number of key functions, for which state responsibilities vary by exchange type. Despite some challenges, the seven selected states in GAO’s review reported they have taken actions to create exchanges, which they expect will be ready for enrollment by the deadline of October 1, 2013


Incentives for Nondiscriminatory Wellness Programs in Group Health Plans - Final Rule

Jun 2013

The Department of Treasury, Department of Labor, and Department of Health and Human Services issued a joint final rule on employment-based, nondiscriminatory wellness programs. Specifically, these final regulations increase the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan from 20 percent to 30 percent of the cost of coverage. The final regulations further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other clarifications regarding the reasonable design of health-contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination


FOA - Grants to States to Support Health Insurance Rate Review and Increase Transparency in Health Care Pricing

May 2013
CMS released a third cycle of Rate Review Grants - Grants to States to Support Health Insurance Rate Review and Increase Transparency in Health Care Pricing, Cycle III of the Rate Review Grant Program. This cycle of funding continues to support rate review efforts in states and bolsters state’s ability to establish or enhance data centers which collect, analyze, and publish reimbursement and health pricing data. 

Facilitating Medicaid and CHIP Enrollment and Renewal in 2014

May 2013

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. 

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