Agencies Outline Plans for Issuing Rules under Affordable Care Act

On January 20, 2012 various federal agencies released their regulatory agendas for the coming year. These documents describe which rules agencies such as the U.S. Department of Health and Human Services (HHS) and the Department of Labor’s Employee Benefits Security Administration (EBSA) intend to develop and/or issue in proposed and final form within the next 12 months. The agencies also released information on longer-term regulatory actions. A number of these regulatory efforts address changes made by the Affordable Care Act.

According to the HHS’s statement of regulatory priorities for 2012, the HHS’s Centers for Medicare & Medicaid Services (CMS) will finalize a number of rules related to the expansion of access to and information about health insurance coverage. Although the CMS’s regulatory plan lists 46 separate rules under development at the proposed and final stages, the CMS has designated the following regulatory efforts as priorities:

  • One final rule will establish the Affordable Insurance Exchanges (Exchanges) designed to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options.  This is a statutory requirement that will be effective as of January 1, 2014.
  • The CMS intends to issue a proposed rule by April 2012 that would implement section 1311 of the Affordable Care Act. According to the CMS, this proposal concerning the future health Exchanges will address the requirements for Qualified Health Plans “and is more implementation-focused on elements such as the Essential Health Benefits and oversight of the Exchanges.”
  • Another rule aims to “make coverage more secure by offsetting market uncertainty and risk selection to maintain the viability of Exchanges.” Specifically, the HHS, in consultation with the states, will develop state requirements related to reinsurance, risk corridors, and permanent risk adjustment. According to the HHS, the goal of these programs is to “minimize negative impacts of adverse selection inside the Exchanges.”
  • A separate final rule scheduled for a February 2012 release seeks to expand eligibility for Medicaid coverage.

Another imminent final rule will establish the requirements of the Summary of Benefits and Coverage (SBC) disclosure that health insurers and group health plans must provide to consumers to enable them to better compare benefits and coverage. The CMS issued a proposed rule on this topic in August 2011.  A final rule, which will also “set standards for the definitions of terms used in health insurance coverage, including specific terms” provided in the Affordable Care Act, is expected to be issued shortly.  HHS also plans to issue a final rule on waivers for state innovation in the near future.

The Department of Labor’s Employee Benefits Security Administration (EBSA) is also responsible – in conjunction with the HHS – for implementing Affordable Care Act regulations. Many of the EBSA’s regulatory efforts, however, are considered longer-term goals. Such long-term goals include issuing rules on the following:

  • Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient Protection and Affordable Care Act
  • Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act
  • Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions and Patient Protections Under the Affordable Care Act
  • Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act
  • Group Health Plans and Health Insurance Issuers Relating to Internal and External Appeals Processes Under the Patient Protection and Affordable Care Act
  • Automatic Enrollment in Health Plans of Employees of Large Employers Under FLSA Section 18A
  • Group Health Plans and Health Insurance Issuers Relating to the Summary of Benefits and Coverage and the Uniform Glossary Required Under the Affordable Care Act

Detailed information on these regulatory items can be found here

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Information contained in this publication is intended for informational purposes only and does not constitute legal advice or opinion, nor is it a substitute for the professional judgment of an attorney.