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Agencies Outline Plans for Issuing Rules Under Affordable Care Act

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Last month, various federal agencies released their regulatory agendas for the coming year. These documents describe which rules they intend to develop and/or issue in proposed and final form within the next 12 months.

According to a statement from the U.S. Department of Health and Human Services (HHS) on regulatory priorities for 2012 (here), the HHS's Centers for Medicare and Medicaid Services (CMS) will finalize a number of rules related to the expansion of access to and information about health insurance coverage. Although the plan lists 46 separate rules under development at the proposed and final stages, the CMS designates these regulatory efforts as priorities:

  • A final rule to establish the Affordable Insurance Exchanges (Exchanges) designed to provide competitive marketplaces for individuals and small employers to directly compare available private health insurance options.
  • 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."
  • A rule aiming 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.
  • A separate final rule scheduled for release this month 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 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. Subjects of these goals include the following:

  • dependant coverage up to age 26
  • coverage relating to status as a grandfathered health plan
  • preexisting condition exclusions, lifetime/annual limits, rescissions and patient protections
  • coverage of preventive services
  • internal/external appeals processes
  • automatic enrollment under FLSA Section 18A
  • Summary of Benefits and Coverage and the Uniform Glossary

Detailed information on these regulatory items is available here.

Want to know more? Read the full article by Ilyse Schuman at Littler Mendelson