Rules Aim to Implement Standards to Ensure Quality Insurance Choices for Americans
In
addition to the Multi-State Plan Program final rule issued Friday, the federal
government released other rules implementing portions of the Affordable Care
Act to encourage cost-sharing, stabilize health insurance premiums, and prevent
providers from denying coverage.
The
Notice of Benefit and Payment Parameters final rule expands upon the standards
set forth in earlier rules and provides further information on the permanent
risk adjustment, transitional reinsurance and temporary risk corridors
programs, advance payments of the premium tax credit, cost-sharing reductions,
medical loss ratio, and the Small Business Health Options Program (SHOP).
Key
policies in this rule:
- Reduce
the incentives for health insurance issuers to avoid enrolling people with
preexisting conditions.
- Stabilize
premiums in the individual market for health insurance.
- Protect
health insurance issuers against uncertainty in setting premium rates.
- Help
working Americans afford health insurance in the Exchanges.
- Finalize
a number of provisions to provide qualified health plan (QHP) options for the SHOP.
- Amend
the Medical Loss Ratio program, also known as the 80/20 rule.
A
proposed rule seeks to amend
existing regulations to implement the SHOP effective January 1, 2015.
An
interim final regulation
will adjust risk corridors
calculations that
would align the calculations with
the single risk pool provision. It also sets standards permitting issuers of QHPs the option of using an alternate methodology for calculating the value of cost-sharing reductions
provided for the purpose of reconciliation of advance payments of cost-sharing
reductions.