Resources from the Federal Government

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Multi-State Plan Program Issuer Letter

Feb 2014

This is OPM’s annual call for applications and recertification submissions from prospective and current Multi-State Plan (MSP) issuers for the contract term beginning January 1, 2015. The MSP Program was created to bring choice and competition to the Health Insurance Marketplace. The Program’s charge is to make available at least two quality, affordable MSP options in the Marketplace in every State and the District of Columbia. In the inaugural year, OPM certified more than 150 MSP options that are now available to consumers in 30 States and the District of Columbia. OPM also certified MSP options for the Small Business Health Options Program (SHOP) in four States and the District of Columbia. For 2015, OPM’s goal is to expand MSP coverage to at least five additional States, and to add one or more new MSP issuers or groups of issuers.


Draft 2015 Letter to Issuers in the Federally-facilitated Marketplace

Feb 2014

The Centers for Medicare and Medicaid Services (CMS) is releasing this draft Letter to Issuers in the Federally-facilitated Marketplaces (FFMs). This Letter provides issuers seeking to offer Qualified Health Plans (QHPs), including stand-alone dental plans (SADPs), in an FFM and/or Federally-facilitated Small Business Health Options Program (FF-SHOP), with operational and technical guidance to help them success fully participate in the Marketplaces. Comments on this draft are due by February 25.


Minimum Essential Coverage and Other Rules Regarding the Shared Responsibility Payment for Individuals

Feb 2014

This document contains proposed regulations relating to the ACA requirement to maintain minimum essential coverage. It stipulates that while certain types of Medicaid coverage and military health programs do not qualify as minimum essential coverage, individuals enrolled in these programs will not be subject to the shared responsibility payment for 2014. This proposed rule also provides more detail on hardship exemptions and enrollment in employer-sponsored health insurance plans.


Health Insurance Marketplace: January Enrollment Report

Jan 2014

This is the third in a series of issue briefs highlighting national and state-level enrollment-related information for the Health Insurance Marketplace. This brief includes data for states that are implementing their own Marketplaces, and states with Marketplaces that are supported by or fully run by the Department of Health and Human Services. This brief also includes some preliminary data on the characteristics of persons who have selected a Marketplace plan by gender, age, and financial assistance status, and of the plans that they have selected by metal level.


Basic Health Program: Proposed Federal Funding Methodology for Program Year 2015

Jan 2014

In this recent release, CMS proposes the methodology and data sources necessary to determine federal payment amounts made to states that elect to establish a Basic Health Program (BHP). The BHP program, which is scheduled to begin in January 2015, will offer health benefits coverage to low-income individuals otherwise eligible to purchase coverage through the health insurance marketplaces. Comments on the proposed funding methodology are due by January 22, 2014.


Trends in Health Care Cost Growth and the Role of the Affordable Care Act

Dec 2013

The ACA was passed against a backdrop of decades of rapid growth in health care spending in the United States. While much of this historical increase reflects the development of new treatments that have greatly improved health and well-being, there is widespread agreement that the system suffered from serious inefficiencies that increased costs and reduced the quality of care that patients receive. A key goal of the ACA was to begin wringing these inefficiencies out of the health care system, simultaneously reducing the growth of health care spending – and its burden on families, employers, and state and federal budgets – while increasing the quality of the care delivered. This report analyzes recent trends in health care costs, the forces driving those trends, and their likely economic benefits.


Proposed Quality Rating System Framework for Qualified Health Plans

Dec 2013

This notice with comment describes the overall Quality Rating System (QRS) framework for rating Qualified Health Plans (QHPs) offered through an Exchange. The purpose of this notice is to solicit comments on the list of proposed QRS quality measures that QHP issuers would be required to collect and report, the hierarchical structure of the measure sets and the elements of the QRS rating methodology. In addition, this notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development.


Proposed Rule: HHS Notice of Benefit and Payment Parameters for 2015

Dec 2013

This proposed rule sets forth payment parameters and oversight provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also proposes additional standards with respect to composite rating, privacy and security of personally identifiable information, the annual open enrollment period for 2015, the actuarial value calculator, the annual limitation in cost sharing for stand-alone dental plans, etc.


Final Rule: Health Insurance Providers Fee

Dec 2013

This final rule establishes the annual fee that will be imposed on health insurers, HMOS, self-insured Multiple Employment Welfare Arrangements (MEWAs), and entities that provide coverage under Medicare Parts C and D and Medicaid beginning in 2014. This health insurance tax is intended to help fund the insurance coverage expansion under the ACA.


Mental Health Parity and Addiction Equity Act – Final Rule

Nov 2013

This final rule maintains the protections of the Mental Health Parity Act of 1996 and adds new protections. The rule requires insurance companies to offer mental health and substance-use disorder benefits that are comparable to their medical and surgical benefits. However, the final rule does not require employers to offer mental health coverage.

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