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  • HHS Proposes Standards for Minimum Essential Coverage

    A proposed rule issued Wednesday includes vital provisions regarding minimum essential coverage as mandated by the Affordable Care Act.

    Under the ACA, nonexempt individuals are required to maintain minimum essential coverage or make a shared responsibility payment. This provision is known as the individual mandate. The ACA specifies the categories of individuals who are eligible to receive exemptions from the shared responsibility payment under section 5000A of the Internal Revenue Code, which provides nonexempt individuals with a choice: maintain minimum essential coverage for themselves and any nonexempt family members or include an additional payment with their federal income tax return.

    This proposed rule sets forth standards and processes under which the health insurance exchanges will conduct eligibility determinations for and grant certificates of exemption from the shared responsibility payment.

    The proposal also provides standards for determining whether certain other types of health insurance coverage constitute minimum essential coverage and procedures for sponsors to follow for a plan to be identified as minimum essential coverage under section 5000A.

    Additionally, it proposes to designate certain types of existing health coverage as minimum essential coverage. Sponsors of a health plan that seek to have such coverage recognized as minimum essential coverage would have to submit information, including the essential health benefits covered, to the Department of Health and Human Services (HHS). Among the essential health benefits required in the ACA are rehabilitation and habilitation services and devices.

    This proposed rule, which complements a proposed rule issued the same day by the Internal Revenue Service, is published in today's Federal Register.

    Comments on the rule are due March 18. APTA will analyze the proposed rule to determine if it is necessary for the association to submit comments.  


    • I would like to see APTA work with AMA and HHS/CMS to create a code/benefit of one preventive screening per year that would include cardiovascular, musculoskeletal and biometric data to be provided by PTs. Direct Access can provide a place at the table for us as these changes roll out.

      Posted by Chip OMalley on 2/1/2013 1:06 PM

    • Doesn't the association consider health, wellness, and chronic disease management of interest to us as well as rehab and habilitation?

      Posted by Kathleen on 2/1/2013 3:46 PM

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