ACA Now

Implementation Status

2013

A February 25, 2013, HHS final rule implements this section’s provisions relative to, as of policy and plan years beginning on or after January 1, 2014, requiring coverage of the essential health benefits package in the individual and small group markets. The rule also implements this section’s provisions regarding offering child-only plans but reserves for future rulemaking the provision regarding cost-sharing under group health plans.

Also see an HHS release and a CCIIO fact sheet on the broader rule implementing these provisions.

Following media attention to the issue in August, first announced in February 2013 DOL guidance, Deputy Assistant to the President for Health Policy Jeanne Lambrew on August 13 posted on the White House blog about consumer out-of-pocket limits under this section, saying they are “are taking effect next year, on time.” She noted the DOL guidance provisions with respect to certain employer plans that “use separate benefit administrators for their insurance coverage (for instance one for major medical coverage and another for drug coverage), adding, “[t]ech systems cannot communicate with one another yet, so the guidance allowed these existing plans to separately limit out of pocket spending on major medical expenses, and drug plans that currently have out-of-pocket limits” in 2014.

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. 9, in a wide-ranging set of FAQs, DOL, HHS and Treasury stipulate that non-grandfathered plans cover breast cancer chemoprevention drugs on a first-dollar basis for specified women at increased risk, as recently recommended by the USPSTF, for plan or policy years after Sept. 24, 2014; and clarify that ACA out-of-pocket maximums apply in 2015 across all essential health benefits (EHBs), despite a 2014 transitional policy that allowed some plans with separate prescription drug or pediatric dental benefit administrators, for example, to apply separate OOP maximums to such benefits. Additional FAQs address expatriate health plans, wellness programs and the ACA’s effect on mental health parity in the individual and small group markets.

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 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.

2016

On Apr. 20, HHS, DOL, and the Treasury issued joint FAQs regarding implementation of ACA market reform provisions, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), and the Women’s Health and Cancer Rights Act of 1998 (WHCRA). Specific market reforms made by the ACA, including emergency services protections, coverage of preventive services, prohibition on rescissions, coverage of individuals participating in approved clinical trials, and limitations on cost sharing, are all addressed.