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 2014_register executive 2014-05-24 article Part II Rules and Regulations D09002ee1c7fa0828 D09002ee1c7fa094f United States Department of Health and Human Services originator org United States Government Agency or Subagency This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges ("Exchanges"), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non- formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed. 79 FR 30240 https://www.govinfo.gov/app/details/FR-2014-05-27/2014-11657 2014-11657 fr27my14-14 RIN 0938-AS02 4120-01-P CMS-9949-F https://www.govinfo.gov/app/details/FR-2014-05-27/2014-11657 https://www.govinfo.gov/content/pkg/FR-2014-05-27/html/2014-11657.htm https://www.govinfo.gov/content/pkg/FR-2014-05-27/pdf/2014-11657.pdf Health Care Health Insurance Reporting and Record Keeping Requirements Reporting and Recordkeeping Requirements State Regulation of Health Insurance Administrative Practice and Procedure Penalties Adverse Selection Health Records Organization and Functions (Government Agencies) Premium Stabilization Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Claims Health Plans 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 Premium Revenues Medical Loss Ratio Rebating 114 p. 30240 30353 79 FR 30240 Title 45 Part 144 45 CFR Part 144 Title 45 Part 146 45 CFR Part 146 Title 45 Part 147 45 CFR Part 147 Title 45 Part 148 45 CFR Part 148 Title 45 Part 153 45 CFR Part 153 Title 45 Part 154 45 CFR Part 154 Title 45 Part 155 45 CFR Part 155 Title 45 Part 156 45 CFR Part 156 Title 45 Part 158 45 CFR Part 158 RIN 0938-AS02 Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond; Federal Register Vol. 79, Issue RULE 2014-11657 II DEPARTMENT OF HEALTH AND HUMAN SERVICES 2014-07-28 CMS-9949-F 4120-01-P 2014-11657 Final rule.

This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges ("Exchanges"), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: A modification of HHS's allocation of reinsurance collections if those collections do not meet our projections; certain changes to allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996 including excepted benefits; standards regarding how enrollees may request access to non- formulary drugs under exigent circumstances; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio (MLR) program. The majority of the provisions in this rule are being finalized as proposed.

This rule is effective July 28, 2014 except for amendments to 45 CFR 155.705 which are effective May 27, 2014. For general matters and matters related to Parts 144, 146, 147, 148 and 154: Jacob Ackerman, (301) 492- 4179. Health Care Health Insurance Reporting and Record Keeping Requirements Reporting and Recordkeeping Requirements State Regulation of Health Insurance Administrative Practice and Procedure Penalties Adverse Selection Health Records Organization and Functions (Government Agencies) Premium Stabilization Reinsurance Risk Adjustment Risk Corridors Risk Mitigation State and Local Governments Claims Health Plans 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 Premium Revenues Medical Loss Ratio Rebating Patient Protection and Affordable Care Act: Exchange and Insurance Market Standards for 2015 and Beyond , HIPAAOptOut@cms.hhs.gov Paperwork@cms.hhs.gov shop@cms.hhs.gov http://marketplace.cms.gov/help-us/common-qandas-about-cac-designation.pdf http://www.cms.gov/CCIIO/Resources/Data-Resources/mlr.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/Affordable http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/AffordableCareAct_implementation_faqs18.html http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/qa_hmr.html http://www.cms.gov/CCIIO/Resources/Files/Downloads/hipaa_08_01_508.pdf http://www.cms.gov/CCIIO/Resources/Files/Downloads/opt_out_memo.pdf http://www.cms.gov/CCIIO/Resources/Forms-Reports-and-Other-Resources/Downloads/hipaa-optout-nfgp-list-05-06-2014.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/2015-final-issuer-letter-3-14-2014.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/draft-discontinuance-renewal-notices-03-14-14.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/mec-guidance-10-31-2013.pdf 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.hhs.gov/PaperworkReductionActof1995 http://www.dol.gov/ebsa/faqs/faq-Affordable http://www.dol.gov/ebsa/faqs/faq-AffordableCareAct18.html http://www.dol.gov/ebsa/pdf/fab2007-4.pdf http://www.gpo.gov/fdsys http://www.gpo.gov/fdsys/pkg/FR-2012-06-21/html/2012-15162.htm http://www.gpo.gov/fdsys/pkg/FR-2012-11-27/pdf/2012-28473.pdf http://www.irs.gov/irb/2008-7_IRB/ar09.html http://www.irs.gov/pub/irs-drop/rp-13-25.pdf http://www.regulations.gov http://www.sba.gov https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/QRS-Scoring-Specification.pdf https://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html Vol. 79, no. 101 Office of the Federal Register, National Archives and Records Administration 2014-05-27 continuing daily deposited born digital 437 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2014-05-27 P0b002ee18928741f 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr27my14 https://www.govinfo.gov/app/details/FR-2014-05-27 https://www.govinfo.gov/content/pkg/FR-2014-05-27/pdf/FR-2014-05-27.pdf https://www.govinfo.gov/content/pkg/FR-2014-05-27/xml/FR-2014-05-27.xml fdlp 30003 30429 DGPO 2014-05-24 2024-06-02 FR-2014-05-27 machine generated eng FR FR-2014-05-27 79 101