ACA Now

Implementation Status

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 renewability. 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.

On May 14, CCIIO released FAQs on Health Insurance Marketplaces addressing issues involving: (1) CMS oversight of state-operated premium stabilization programs, advance payments of the premium tax credit and cost-sharing reductions; (2) issuer oversight in Federally Facilitated Marketplaces; (3) State-Based Marketplace reporting requirements; (4) privacy and security standards for State-Based Marketplaces and consumer assistance personnel; (5) cost-sharing reductions and health savings accounts; (6) eligibility and enrollment – specifically, CMS’s intent to “propose rulemaking and supplemental guidance on the use of [Health Plan Identifiers] in enrollment and payment transactions between issuers and the Federally Facilitated Marketplace”; and (7) issuer withdrawal from the small group or large group market.

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 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).

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 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.

On May 26, CCIIO released FAQs on ACA cost-sharing limitations (also see May 8 FAQs) and non-discrimination provisions.

On Sept. 2, 2016 CCIIO posted updated federal standard renewal and product discontinuation notices based on enrollees’ movement out of the service areas. They are generally for use beginning in 2018 policy years.

On Sept. 16, 2016 CMS released an information collection notice addressing 2017 annual redeterminations and reenrollments, as well as specified discontinuation notices (see above). Comments are due by Oct. 17.

2017

On June 1, CCIIO said it will continue to provide an enforcement safe harbor for plans’ provision of discontinuation notices to individual market enrollees of products that will no longer be offered in the 2018 benefit year. The ACA envisioned 90 days’ notice of discontinuation but, as in previous years, CCIIO cites QHP finalization close to the start of open enrollment as impeding plans’ ability to meet that requirement.