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2014-03-11
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Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015
Part II
Rules and Regulations
D09002ee1bdc70aa9
D09002ee1bdc70c24
United States
Department of Health and Human Services
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org
United States Government Agency or Subagency
This final 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 provides additional standards with respect to composite premiums, 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, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.
79 FR 13744
https://www.govinfo.gov/app/details/FR-2014-03-11/2014-05052
2014-05052
fr11mr14-23
RIN 0938-AR89
4120-01-P
CMS-9954-F
https://www.govinfo.gov/app/details/FR-2014-03-11/2014-05052
https://www.govinfo.gov/content/pkg/FR-2014-03-11/html/2014-05052.htm
https://www.govinfo.gov/content/pkg/FR-2014-03-11/pdf/2014-05052.pdf
Health Care
Health Insurance
Reporting and Recordkeeping Requirements
State Regulation of Health Insurance
Administrative Practice and Procedure
Adverse Selection
Health Records
Organization and Functions (Government Agencies)
Premium Stabilization
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
Administrative Appeals
Administration and Calculation of Advance Payments of Premium Tax Credit
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
Payment and Collections Reports
Public Assistance Programs
Sunshine Act
Technical Assistance
Women
Youth
Claims
Health Plans
Penalties
Premium Revenues
Medical Loss Ratio
Rebating
100 p.
13744
13843
79 FR 13744
Code of Federal Regulations
Title 45 Part 144
45 CFR Part 144
Code of Federal Regulations
Title 45 Part 147
45 CFR Part 147
Code of Federal Regulations
Title 45 Part 153
45 CFR Part 153
Code of Federal Regulations
Title 45 Part 155
45 CFR Part 155
Code of Federal Regulations
Title 45 Part 156
45 CFR Part 156
Code of Federal Regulations
Title 45 Part 158
45 CFR Part 158
Regulation Identification Number 0938-AR89
RIN 0938-AR89
Patient Protection and Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015; Federal Register Vol. 79, Issue
RULE
2014-05052
II
DEPARTMENT OF HEALTH AND HUMAN SERVICES
2014-05-12
CMS-9954-F
4120-01-P
2014-05052
Final rule.
This final 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 provides additional standards with respect to composite premiums, 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, the meaningful difference standard for qualified health plans offered through a Federally-facilitated Exchange, patient safety standards for issuers of qualified health plans, and the Small Business Health Options Program.
These regulations are effective on May 12, 2014.
For general information: Sharon Arnold, (301) 492-4286; Laurie McWright, (301) 492-4311; or Jeff Wu, (301) 492-4305. For matters related to student health insurance coverage and composite premiums: Jacob Ackerman, (301) 492-4179. For matters related to the risk adjustment program: Kelly Horney, (410) 786-0558. For general matters related to the reinsurance program: Adrianne Glasgow, (410) 786-0686. For matters related to reinsurance contributions: Adam Shaw, (410) 786- 1019. For matters related to risk corridors: Jaya Ghildiyal, (301) 492-5149. For matters related to medical loss ratio: Christina Pavlus, (301) 492- 4172. For matters related to cost-sharing reductions and netting of payments and charges: Pat Meisol, (410) 786-1917. For matters related to the premium adjustment percentage: Johanna Lauer, (301) 492-4397. For matters related to Federally-facilitated Exchange user fees: Michael Cohen, (301) 492-4277. For matters related to the annual limitation on cost sharing for stand- alone dental plans, privacy and security of personally identifiable information, the annual open enrollment period for 2015, and the meaningful difference standard: Leigha Basini, (301) 492-4380. For matters related to the Small Business Health Options Program: Christelle Jang, (410) 786-8438. For matters related to the actuarial value calculator: Allison Yadsko, (410) 786-1740. For matters related to patient safety standards for issuers of qualified health plans: Nidhi Singh Shah, (301) 492-5110.
Health Care
Health Insurance
Reporting and Recordkeeping Requirements
State Regulation of Health Insurance
Administrative Practice and Procedure
Adverse Selection
Health Records
Organization and Functions (Government Agencies)
Premium Stabilization
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
Administrative Appeals
Administration and Calculation of Advance Payments of Premium Tax Credit
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
Payment and Collections Reports
Public Assistance Programs
Sunshine Act
Technical Assistance
Women
Youth
Claims
Health Plans
Penalties
Premium Revenues
Medical Loss Ratio
Rebating
Patient Protection and Affordable Care Act:
Benefit and Payment Parameters for 2015
,
actuarialvalue@cms.hhs.gov
OIRA_submission@omb.eop.gov
Paperwork@cms.hhs.gov
HealthCare.gov
http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf
http://pcaobus.org/Standards/Auditing/Pages/default.aspx
http://www.aicpa.org/Research/Standards/AuditAttest/Pages/SAS.aspx
http://www.cbo.gov/sites/default/files/cbofiles/attachments/43900-2014-02-ACAtables.pdf
http://www.cms.gov/CCIIO/Programs-and-Initiatives/Premium-Stabilization-Programs/index.html
http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs18.html
http://www.cms.gov/CCIIO/Resources/Files/Downloads/opt_out_memo.pdf
http://www.cms.gov/CCIIO/Resources/Letters/Downloads/commissioner-letter-11-14-2013.PDF
http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/2014_letter_to_issuers_04052013.pdf
http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/mec-guidance-10-31-2013.pdf
http://www.cms.gov/cciio/resources/regulations-and-guidance/index.html#MinimumAcceptableRiskStandards
http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/Proj2012.pdf
http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/ProjectionsMethodology2012.pdf
http://www.dol.gov/ebsa/faqs/faq-aca18.html
http://www.dol.gov/ebsa/pdf/2013-5500inst.pdf
http://www.gao.gov/yellowbook
http://www.irs.gov/pub/irs-drop/rp-13-25.pdf
http://www.nadp.org/Libraries/HCR_Documents/phsa027.sflb.ashx
http://www.rand.org/pubs/reports/R3055
https://www.regtap.info/uploads/library/ACA_HHS_OperatedRADVWhitePaper_062213_5CR_062213.pdf
https://www.regtap.info/uploads/library/HHS_OperatedDataCollectionPolicyFAQs_062613
Federal Register
Vol. 79, no. 47
Office of the Federal Register, National Archives and Records Administration
2014-03-11
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384 p.
Table of Contents:
AE 2.7:
GS 4.107:
AE 2.106:
KF70.A2
https://www.govinfo.gov/app/details/FR-2014-03-11
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0042-1219
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000582072
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https://www.govinfo.gov/app/details/FR-2014-03-11
https://www.govinfo.gov/content/pkg/FR-2014-03-11/pdf/FR-2014-03-11.pdf
https://www.govinfo.gov/content/pkg/FR-2014-03-11/xml/FR-2014-03-11.xml
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