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  • 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.

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