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Focus on Regulation

Tag Archives: Insurance

CMS Proposes Network Adequacy Standards for 2017 as State Regulators Approve Network Access and Adequacy Model Law

On November 22, 2015, the National Association of Insurance Commissioners (NAIC) approved new standards designed to ensure that consumers have adequate access to doctors, hospitals, and other healthcare providers under health benefit plans that use provider networks. Read More: CMS Proposes Network Adequacy Standards for 2017 as State Regulators Approve Network Access and Adequacy Model

OPM Releases Final Rule on the Affordable Care Act’s Multi-State Plan Program

The U.S. Office of Personnel Management (OPM) released a final rule on March 1st establishing the Multi-State Plan Program (MSPP) pursuant to the Affordable Care Act. It is substantially the same as the proposed rule, with conforming changes to the non-discrimination provisions to conform to recent changes in the final Essential Health Benefits regulation. The

CMS Releases Final Rule on the Affordable Care Act’s Health Insurance Reforms

The Centers for Medicare and Medicaid Services (CMS) released a final rule on February 22, 2013, implementing four key consumer protections enacted by the Affordable Care Act, including: Guaranteed Availability: Health insurance issuers must sell health insurance policies to all consumers who apply for coverage, regardless of health status. Guaranteed Renewability: Health insurance issuers will

OPM Releases Proposed Approach to Multi-State Plans

On November 30, 2012, the Office of Personnel Management (OPM) released a proposed rule in which the agency set forth the process through which it will establish the Multi-State Plan Program (MSPP), and the standards and requirements for both issuers and plans in the MSPP. In an effort to enhance competition among plans offered through

CMS Releases Proposed Rule on Health Insurance Markets and Rate Reviews

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule implementing the Patient Protection and Affordable Care Act’s (PPACA) requirements regarding health insurance markets, guaranteed availability and renewability of health insurance coverage, permissible factors for setting premiums, and risk pooling requirements.  Today, 43 states permit individual premiums to be based on health status

CMS Seeks Comments on Qualified Health Plan Certification Requirements and Exchange Enrollment Forms

Following the Supreme Court’s June 28 decision regarding the Patient Protection and Affordable Care Act (PPACA), CMS has requested comments on the likely burden of the following four proposed data collection activities, each of which pertains to the health insurance exchanges to be established by 2014.  These data collection requirements are imposed on Exchanges, employees,

CMS Releases Additional Information Regarding the Benchmark Plans to be Used in Defining the Essential Health Benefits

CMS’ Center for Consumer Information and Insurance Oversight (CCIIO) posted a document entitled “Essential Health Benefits: List of the Largest Three Small Group Products by State” on its website on July 2, 2012.  Beginning in 2014, non-grandfathered plans in the individual and small group markets offered both inside and outside of the state health insurance

One Day After Supreme Court Decision, HHS Announces Additional Exchange Funding

One day after the Supreme Court upheld the Patient Protection and Affordable Care Act (PPACA)—bringing new urgency to state efforts to establish health insurance Exchanges under the law—HHS released a new Funding Opportunity Announcement (FOA) entitled “Cooperative Agreement to Support Establishment of Affordable Care Act’s Health Insurance Exchanges.”  According to HHS’s press release, the Department

Supreme Court Issues Long-Awaited Health Reform Decision: Upholds Entire Law, but Imposes Certain Restrictions on Medicaid Expansion

In the most closely-watched decision of its 2012 term, Chief Justice Roberts delivered the opinion for a majority of a divided Supreme Court today upholding the individual mandate in the Affordable Care Act (ACA).  The vote was 5-to-4.  While the Court also upheld the Medicaid expansion, it narrowly read the federal government’s power to terminate

CMS Limits Reporting Requirements for Plans that Meet Medical Loss Ratio Standard

The Patient Protection and Affordable Care Act (PPACA) restricts the percent of premium dollars that health insurers may spend on administration, marketing and profits, the Medical Loss Ratio (MLR). The Centers for Medicare and Medicaid Services (CMS) has amended its regulations governing MLR standards for health insurers to create notice requirements for insurers who meet