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2014-05-24
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Patient Protection and Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond
Part II
Rules and Regulations
D09002ee1bdc439cf
D09002ee1bdc43af7
United States
Department of Health and Human Services
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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
Code of Federal Regulations
Title 45 Part 144
45 CFR Part 144
Code of Federal Regulations
Title 45 Part 146
45 CFR Part 146
Code of Federal Regulations
Title 45 Part 147
45 CFR Part 147
Code of Federal Regulations
Title 45 Part 148
45 CFR Part 148
Code of Federal Regulations
Title 45 Part 153
45 CFR Part 153
Code of Federal Regulations
Title 45 Part 154
45 CFR Part 154
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-AS02
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
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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
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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
Federal Register
Vol. 79, no. 101
Office of the Federal Register, National Archives and Records Administration
2014-05-27
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Table of Contents:
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https://www.govinfo.gov/app/details/FR-2014-05-27
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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
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