United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2013_register executive 2013-03-09 article Part II Rules and Regulations D09002ee1c7fbc37c D09002ee1c7fbc400 United States Department of Health and Human Services originator org United States Government Agency or Subagency This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs--risk adjustment, reinsurance, and risk corridors--to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance. 78 FR 15410 https://www.govinfo.gov/app/details/FR-2013-03-11/2013-04902 2013-04902 fr11mr13-12 RIN 0938-AR51 4120-01-P CMS-9964-F https://www.govinfo.gov/app/details/FR-2013-03-11/2013-04902 https://www.govinfo.gov/content/pkg/FR-2013-03-11/html/2013-04902.htm https://www.govinfo.gov/content/pkg/FR-2013-03-11/pdf/2013-04902.pdf Administrative Practice and Procedure Adverse Selection Health Care Health Insurance Health Records Organization and Functions (Government Agencies) Premium Stabilization Reporting and Recordkeeping Requirements Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Health Care Access Cost-Sharing Reductions Advance Payments of Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Advertising Advisory Committees Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals American Indian/Alaska Natives Individuals with Disabilities Loan Programs-Health Medicaid Public Assistance Programs Sunshine Act Technical Assistance Women Youth Employee Benefit Plans Indians Safety Technical Assistance Claims Health Plans Penalties Premium Revenues Medical Loss Ratio Rebating 132 p. 15410 15541 78 FR 15410 Title 45 Part 153 45 CFR Part 153 Title 45 Part 155 45 CFR Part 155 Title 45 Part 156 45 CFR Part 156 Title 45 Part 157 45 CFR Part 157 Title 45 Part 158 45 CFR Part 158 RIN 0938-AR51 Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2014; Federal Register Vol. 78, Issue RULE 2013-04902 II DEPARTMENT OF HEALTH AND HUMAN SERVICES 2013-04-30 CMS-9964-F 4120-01-P 2013-04902 Final rule.

This final rule provides detail and parameters related to: the risk adjustment, reinsurance, and risk corridors programs; cost-sharing reductions; user fees for Federally-facilitated Exchanges; advance payments of the premium tax credit; the Federally-facilitated Small Business Health Option Program; and the medical loss ratio program. Cost-sharing reductions and advance payments of the premium tax credit, combined with new insurance market reforms, are expected to significantly increase the number of individuals with health insurance coverage, particularly in the individual market. In addition, we expect the premium stabilization programs--risk adjustment, reinsurance, and risk corridors--to protect against the effects of adverse selection. These programs, in combination with the medical loss ratio program and market reforms extending guaranteed availability (also known as guaranteed issue) and prohibiting the use of factors such as health status, medical history, gender, and industry of employment to set premium rates, will help to ensure that every American has access to high-quality, affordable health insurance.

This final rule is effective on April 30, 2013. Sharon Arnold, (301) 492-4286; Laurie McWright, (301) 492-4311; or Jeff Wu, (301) 492-4305, for general information. Kelly Horney, (410) 786-0558, for matters related to the risk adjustment program generally. Michael Cohen, (301) 492-4277, for matters related to the risk adjustment methodology and the methodology for determining the reinsurance contribution rate and payment parameters. Adrianne Glasgow, (410) 786-0686, for matters related to the reinsurance program. Jaya Ghildiyal, (301) 492-5149, for matters related to the risk corridors program and user fees for Federally-facilitated Exchanges. Johanna Lauer, (301) 492-4397, for matters related to cost-sharing reductions and advance payments of the premium tax credit. Bobbie Knickman, (410) 786-4161, for matters related to the distributed data collection approach for the HHS-operated risk adjustment and reinsurance programs. Rex Cowdry, (301) 492-4387, for matters related to the Small Business Health Options Program. Carol Jimenez, (301) 492-4457, for matters related to the medical loss ratio program. Administrative Practice and Procedure Adverse Selection Health Care Health Insurance Health Records Organization and Functions (Government Agencies) Premium Stabilization Reporting and Recordkeeping Requirements Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Health Care Access Cost-Sharing Reductions Advance Payments of Premium Tax Credit Administration and Calculation of Advance Payments of the Premium Tax Credit Plan Variations Actuarial Value Advertising Advisory Committees Brokers Conflict of Interest Consumer Protection Grant Programs-Health Grants Administration Health Maintenance Organization (Hmo) Hospitals American Indian/Alaska Natives Individuals with Disabilities Loan Programs-Health Medicaid Public Assistance Programs Sunshine Act Technical Assistance Women Youth Employee Benefit Plans Indians Safety Technical Assistance Claims Health Plans Penalties Premium Revenues Medical Loss Ratio Rebating Patient Protection and Affordable Care Act: HHS Notice of Benefit and Payment Parameters for 2014 , http://cciio.cms.gov/resources/data/mlr.html http://cciio.cms.gov/resources/factsheets/aca_implementation_faqs11.html http://cciio.cms.gov/resources/files/Files2/02242012/Av-csr-bulletin.pdf http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://cciio.cms.gov/resources/files/mlr-qna-04202012.pdf http://cciio.cms.gov/resources/files/ra_instructions_proposed_1_2013.pdf http://cciio.cms.gov/resources/files/ra_tables_proposed_1_2013.xlsx http://cciio.cms.gov/resources/regulations/index.html#pm http://naic.org/committees_index_model_description_a_c.htm#accident_health http://www.bls.gov/ncs/ncswage2010.htm http://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/04summerpg119.pdf http://www.gpo.gov/fdsys/pkg/CFR-2011-title26-vol17/pdf/CFR-2011-title26-vol17-sec54-4980B-2.pdf http://www.irs.gov/uac/Newsroom/ACA-Section-1341-Transitional-Reinsurance-Program-FAQs http://www.mass.gov/chia/researcher/health-care-delivery/hcf-data-resources/apcd/ http://www.mass.gov/chia/researcher/health-care-delivery/hcf-data-resources/apcd/submitting-data-to-the-apcd.html http://www.mass.gov/chia/researcher/health-care-delivery/hcf-data-resources/apcd/submitting-data-to-the-apcd.html#regulations http://www.naic.org/documents/committees_ex_mlr_reg_asadopted.pdf http://www.rand.org/pubs/reports/R3055 http://www.whitehouse.gov/sites/default/files/omb/memoranda/fy2007/m07-16.pdf www.dol.gov/ebsa Vol. 78, no. 47 Office of the Federal Register, National Archives and Records Administration 2013-03-11 continuing daily deposited born digital 329 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2013-03-11 P0b002ee183e2a8cd 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr11mr13 https://www.govinfo.gov/app/details/FR-2013-03-11 https://www.govinfo.gov/content/pkg/FR-2013-03-11/pdf/FR-2013-03-11.pdf https://www.govinfo.gov/content/pkg/FR-2013-03-11/xml/FR-2013-03-11.xml fdlp 15277 15596 DGPO 2013-03-09 2024-06-03 FR-2013-03-11 machine generated eng FR FR-2013-03-11 78 47