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Focus on Regulation

Tag Archives: PPACA

Glitches, Delays in Rollout of Healthcare.gov Website May Spark Broad Reforms in How the U.S. Government Purchases IT

In a press conference today announcing changes in the implementation of the Patient Protection And Affordable Care Act, President Obama leveled possibly his harshest, highest-profile criticism of the system that the U.S. Government uses to purchase information technology (IT).  The problems and delays surrounding the implementation of the Healthcare.gov website have shined a public spotlight

CMS Releases Consumer Assistance Programs Final Rule

The Centers for Medicare & Medicaid Services (CMS) released a final rule on Friday, July 12th imposing requirements on various consumer assistance programs available to enrollees in Federally-Facilitated Exchanges (FFEs), State Partnership Exchanges, and to a more limited extent, State-run Exchanges. The final rule adopted conflict-of-interest, training and certification, and meaningful access standards applicable to

CMS Releases Medicaid Health Reform Final Rule

On July 5, 2013, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule, implementing provisions of the Patient Protection and Affordable Care Act (ACA) and the Children’s Health Insurance Program Reauthorization Act.  This rule finalizes provisions of the proposed rule, entitled “Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair

CMS Posts New Open Payments FAQs

The Centers for Medicare and Medicaid Services (CMS) recently released nineteen new FAQs on the Open Payments Program, under the Federal Physician Payments Transparency Act.  Effective August 1, 2013, applicable manufacturers will need to begin tracking payments and transfers of value under the Open Payments Program (also known as the federal Sunshine requirements).  The new

Miscellaneous Minimum Essential Coverage Provisions Final Rule

  The Department of Health and Human Services (“HHS”) released a final rule on June 26, 2013 addressing various aspects of the minimum essential coverage requirements imposed by the Affordable Care Act (“ACA”). Under the ACA, individuals must obtain and maintain health insurance that meets the definition of “minimum essential coverage” or face a tax

HHS Issues Proposed Rule Regarding Program Integrity and the Exchanges

On June 14, 2013, HHS released a Notice of Proposed Rulemaking proposing several new policies with respect to the Exchanges, focusing in large part on program integrity, including with respect to qualified health plans (QHPs) offered through both state-run Exchanges and the Federally-facilitated Exchange (FFE).  The rule also addresses the resolution of certain QHP-related grievances

More Guidance on Medicaid Expansion Released by CMS

Enhanced Federal Matching Funds for the “Newly Eligible”:  On March 29, 2013, CMS released a final rule implementing the statutory increases in federal matching funds for the cost of providing care to individuals newly eligible for Medicaid via the expansion under PPACA.  Specifically, beginning in 2014, states will receive 100% federal matching funds for the

Attention Employers: HHS Issues Two Rules Regarding SHOP Exchanges

Section 1311(b)(1)(B) of the Affordable Care Act requires those States that opt to operate an Exchange to establish a Small Business Health Options Program (SHOP) Exchange through which small businesses can purchase insurance coverage for their employees. HHS established standards for the administration of the SHOP Exchanges in the Exchange Establishment Rule published on March

HHS Finalizes Technical Parameters for Premium Tax Credits, Cost-Sharing Reductions and Other Benefits and Payments Related to Qualified Health Plans and the Exchanges

The final Notice of Benefit and Payment Parameters for 2014, issued on March 1, 2013, establishes the final standards for a number of policies and programs that implement the Affordable Care Act’s reforms to private individual and small group health insurance markets in 2014. These policies are designed to make health insurance more affordable for

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

CMS Releases Final Rule on Essential Health Benefits

On February 20, 2013, the Centers for Medicare and Medicaid Services (CMS) released a final rule providing detailed standards for the essential health benefits (EHB) package as well as actuarial value requirements for plans that must offer EHB. The final rule also addresses the process for entities to become recognized accrediting entities for issuers of

Affordable Care Act – Exemptions to the Individual Mandate

The Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) took another step towards implementing the controversial “individual mandate” imposed by the Affordable Care Act (ACA)—which is set to take effect on January 1, 2014—by jointly issuing two proposed rules to implement the exemptions to that mandate on January 30, 2013.

HHS Announces No Enhanced Federal Matching Funds for Partial Medicaid Expansion, But Still Finds Ways to Ease Administrative Burden and Costs for States

The Patient Protection and Affordable Care Act (ACA) made 100% federal matching funds available through Medicaid for states to provide health benefits to all non-pregnant, childless adults with incomes up to 133 % of the federal poverty level (FPL) starting in 2014 (“the ACA Medicaid expansion”).  Since the Supreme Court decision in National Federation of

IRS Publishes Final Regulations re Medical Device Excise Tax

In the December 7, 2012 Federal Register, the IRS issued the final regulations under the medical device excise tax, accompanied by interim guidance that deals with a number of time-sensitive issues including the determination of the taxable sales price and relief from the penalties associated with deposit with the IRS of the correct tax amount. 

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

HHS Issues Proposed Rule Defining Essential Health Benefits Package and Actuarial Value for Health Plans

On November 20, 2012, the Department of Health and Human Services (HHS) issued a much-anticipated proposed rule providing detailed standards for the essential health benefits package as well as actuarial value requirements for plans that must offer essential health benefits. Under the Patient Protection and Affordable Care Act (ACA), the “essential health benefits” (EHB) are

CMS Releases Final Rules on Home Health, Primary Care and Dialysis Facility Payments

In a busy week leading up to the election, CMS released several final rules, including final rules pertaining to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS), Medicaid payments made to certain primary care physicians and the Home Health Prospective Payment System. ESRD PPS Final Rule In a final rule released on November 2nd, CMS

CMS Awards Two More Loans to CO-OPs

The Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS) announced it is awarding loans to two additional Consumer Operated and Oriented Plans or “CO-OPs” on August 31, 2012.  A CO-OP is a new type of nonprofit private health insurer that is directed by its customers, uses profits

CMS Finalizes Blueprint for State-Based and Partnership Health Insurance Exchanges

The Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS) finalized its instructions to states seeking federal approval to establish a State-based Health Insurance Exchange or participate in a State-Federal Partnership Exchange in its Blueprint for Approval of a State-based or Partnership Exchanges.  The Final Blueprint, issued

Seeing Green: CMMI Announces More Money for State Innovation

CMS’s Center for Medicare and Medicaid Innovation (CMMI) announced on July 19 $275 million in new federal grant money for states interested in designing and testing new approaches to delivering health care in order to “bolster health care quality and decrease costs.”  CMS expects that states participating in this “State Innovation Models Initiative” will work