Insurance Market Reform

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Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation - Proposed Rule

Dec 2012

This proposed rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value, and it proposes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and an amendment which provides an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.


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

Dec 2012

This document proposes amendments to regulations, consistent with the Affordable Care Act, regarding nondiscriminatory wellness programs in group health coverage.


HHS Notice of Benefit and Payment Parameters for 2014

Dec 2012

This proposed rule covers topics including the federal risk adjustment model, reinsurance parameters, cost-sharing reduction payment methodology, and user fees for insurers offering QHPs in federal exchanges.


Small Firm Self-Insurance Under the Affordable Care Act

Dec 2012

The ACA changes the small-group insurance market substantially beginning in 2014, but most changes do not apply to self-insured plans. This brief analyzes this exemption and the coverage decisions small-employers can make.


Proposed HHS Insurance Market Rules Promise Considerable Change to Existing Industry Practices

Dec 2012

The U.S. Department of Health and Human Services (HHS) proposed regulations on November 20 that would implement the Affordable Care Act’s (ACA) dramatic reforms of the way health insurance is priced and sold in the individual and small group markets. This report analyzes the proposed rules and highlights areas in which HHS is seeking public comment.


HHS Proposes Payment Model, Rules for Insurers Designed to Improve Affordability of Health Insurance in Exchanges

Dec 2012

This brief reports on the key provisions of HHS's Notice of Benefit and Payment Parameters for 2014. This proposed rule covers topics including the federal risk adjustment model, reinsurance parameters, cost-sharing reduction payment methodology, and user fees for insurers offering QHPs in federal exchanges.


Office of Personnel Management Releases Proposed Rules to Govern Selection and Operation of Multi-State Plans Under the ACA

Dec 2012

On November 30 the U.S. Office of Personnel Management (OPM) released its proposed rules for the Multi-State Plan Program (MSPP) of the Affordable Care Act (ACA). This brief prepared by Manatt Health Solutions provides an overview of the key provisions of the proposed rule.


Health Insurance Market Reforms: Pre-Existing Condition Exclusions

Oct 2012

This new fact sheet provides an overview of how pre-existing condition exclusions are regulated under current law, and how the ACA will change those regulations in 2014.


Monitoring State Implementation of the Affordable Care Act in 10 States: Rate Review

Sep 2012

This paper describes the status of rate review programs in the 10 states participating in the Robert Wood Johnson Foundation’s monitoring and tracking project: Alabama, Colorado, Maryland, Michigan, Minnesota, New Mexico, New York, Oregon, Rhode Island and Virginia.


Plan Participation in Health Insurance Exchanges: Implications for Competition and Choice

Sep 2012

This brief examines the conditions under which competition in health insurance exchanges is likely to be effective in placing downward pressure on insurance premiums.

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