ACA Now

Implementation Status

2013

On February 27, 2013, HHS issued a final rule implementing these provisions in anticipation of 2014. A February 23, 2013 CCIIO fact sheet provides an overview of relevant provisions, including guaranteed availability. Also on February 27, 2013, CCIIO issued a technical fact sheet providing an overview of the health insurance market reforms final rule.

CCIIO also released a March 15, 2013, fact sheet regarding the ACA market reform enforcement framework. As of March 1, 2013, most states had informed CMS they have enforcement authority or entered into collaborative arrangements with CMS. On March 29, 2013, CCIIO posted a fact sheet with similar information that also reflects recent letters sent to Arizona and Alabama regarding ACA market reforms enforcement.

In an April 26, 2013, Q&A on health insurance market reforms, CCIIO addresses the withdrawal of non-grandfathered business; States’ maintenance of “alternative mechanisms” for HIPAA eligible individuals in light of 2014 guaranteed availability; geographic rating areas; issues associated with the definition of association coverage; and premium adjustment when coverage becomes secondary to Medicare.

On May 6, CCIIO posted an April 30 memo containing Model Language for Individual Market Renewal Notices via the Insurance Standards Bulletin Series. The agency notes that if the language is “provided uniformly to all applicable enrollees” it will be considered acceptable under regulatory requirements barring the use or issuer marketing practices that “have the effect of discouraging the enrollment of persons with significant health needs in health insurance coverage.”

On Nov. 14, coinciding with the President’s remarks on the Administration’s pursuit of an administrative fix for those receiving policy cancellations and following his apology for those facing such cancellations, CCIIO released a letter to state Insurance Commissioners (White House fact sheet) laying out a transitional policy under which insurers “may choose to continue coverage that would otherwise be terminated or cancelled, and affected individuals and small businesses may choose to re-enroll in such coverage” – without complying with 2014 market reforms detailed on p. 2 of the letter – under a set of specified parameters (see p. 2 of the letter). Prior to the announcement, on Nov. 9, CMS also had released a fact sheet on policy cancellation letters and Marketplace options.

On Nov. 21, the Center for Consumer Information and Insurance Oversight released guidance and standard notices for health plans to use in the individual and small group markets under the Administration’s transitional policy for – with state insurance commissioner approval – extending into 2014 non-ACA compliant plans that otherwise would or already have been canceled. Also see a White House blog post and CCIIO Q&A on notices. On Nov. 20, President Obama met with Insurance Commissioners regarding the policy.

On Nov. 25, HHS issued a proposed rule establishing the CY 2015 benefit and payment parameters for the cost-sharing reductions (including the annual limitation on cost-sharing for stand-alone dental plans), advance premium tax credit, reinsurance, and risk adjustment programs as required by the ACA.  In addition, the proposed rule establishes the user fees for the Federally-facilitated Exchanges (FFEs), the annual open enrollment period for 2015, the actuarial value (AV) calculator, and other key provisions as required by the law.  Note that the rule allows for adjustments to the risk corridors and other premium stabilization programs in 2014 to account for the “transitional policy” (see the Nov. 14 CCIIO letter to Insurance Commissioners) that addressed plan cancellations, which could equate to broader risk corridors and thus higher stabilization payments to plans. Comments are due by Dec. 26, 2013.

On Dec. 2, Rep. Darrell Issa (R-CA), chairman of the House Oversight and Government Reform Committee, wrote to 15 insurers asking about, among other issues, ACA-related plan cancellations and providers no longer in networks. On Dec. 4, the House Ways and Means Health Subcommittee held a hearing that addressed, in part, plan cancellations; among those testifying was the Washington state insurance commissioner. On Dec. 6, the House Oversight and Government Reform Committee held an Arizona-based field hearing, “ObamaCare Implementation, The Broken Promise: If You Like Your Current Plan You Can Keep It” (details).

2014

On Jan. 3, CCIIO released Q&As clarifying eligibility for hardship exemption from the individual mandate for policyholders whose plans have been canceled, noting that “in order to receive [the exemption] and be able to purchase catastrophic coverage, you must submit the hardship exemption form and should submit supporting documentation showing your health insurance policy was cancelled to an issuer offering catastrophic coverage in your area.” CCIIO indicates that the agency may contact those not including such documentation; the exemption can be revoked if this substantiation is not provided.

On Feb. 21, in a Report to Congress, CMS’s Office of the Actuary notes that premiums may rise for 11 million workers in fully insured small business plans and decline for 6 million as a result of “guaranteed issue, guaranteed renewability and premium rating provisions of the ACA only.” The report notes a “rather large degree of uncertainty associated with this estimate,” stemming from such factors as policies renewed before 2014.

On March 5, CCIIO issued guidance extending, for two additional years (to October 1, 2016), the transitional policy enabling non-ACA-compliant small group and individual plans to continue if state Insurance Commissioners elect. It extended the hardship exemption from the individual mandate for canceled policyholders, through which they also can gain access to catastrophic plans, to the same date.

On May 16, 2014 CCIIO posted 12 FAQs on a range of ACA-related market reforms and Marketplace issues. Among other points, CCIIO says “we are concerned that waiting periods for specific benefits discourage enrollment of or discriminate against individuals with significant health needs or present or predicted disability.”

On June 3, 2014, expanding on a May 16, 2014, FAQ (see p. 4). CCIIO released guidance saying QHPs can meet guaranteed availability requirements by directing enrollees to the Marketplace. Issuers “are not required to market any QHP for sale outside of the Marketplace,” need not create a “designated pathway for off-Marketplace enrollment” and “will satisfy the guaranteed availability standard if they enroll consumers who wish to enroll outside of the Marketplace using a process employed entirely on an ad hoc basis,” the agency says.

HHS issued letters (Virgin Islands, Northern Mariana Islands, Guam, American Samoa, Puerto Rico) indicating that health insurers issuing coverage in U.S. territories are exempt from certain ACA market reforms since they are not considered “states.”

On Mar. 16, HHS, DOL and Treasury issued a final rule amending the definition of excepted benefits and establishing two pilot programs through which employers may provide certain limited wraparound coverage to individual plans, including those purchased in Marketplaces. One pilot enables limited wraparound coverage only for ACA Multi-State Plans, while the other permits it for “part-time workers who enroll in an individual health insurance policy or in Basic Health Plan coverage for low-income individuals established under the Affordable Care Act.