On March 17, 2014, the Centers for Medicare and Medicaid Services (CMS) issued for public inspection a proposed rule regarding the Exchange and Insurance Market Standards for 2015 and later years. The proposed rule addresses requirements under the Affordable Care Act (ACA) applicable to insurance issuers, exchanges, and other entities.
The proposed rule outlines standards for product discontinuation and renewal, quality reporting, non-discrimination, minimum certification, and responsibilities of qualified health plan issuers. In addition, with respect to the transitional reinsurance program, the rule proposes modifying the Department of Health and Human Services’ (HHS) allocation of reinsurance contributions that are collected when contributions fail to meet projections. Moreover, the proposed rule suggests changes to the ceiling on allowable administrative expenses in the risk corridor calculations, and modifications to CMS’ method for calculating cost-sharing parameters.
The proposed rule further identifies approaches that CMS is considering to index the required contribution used to determine exemption eligibility from the shared responsibility payment under Internal Revenue Code section 5000A. Finally, the proposed rule includes the following: grounds for imposing civil money penalties on persons providing false information to the Exchange and on persons who improperly use information; updated standards for consumer assistance; standards relating to the opt-out provisions for self-funded plans and the individual market provisions; standards for recognizing foreign group health coverage as minimum essential coverage; amendments to Exchange appeals standards; and adjustments to standards regarding the medical loss ratio program.
The full text of the proposed rule is available here and was published in the March 21, 2014 Federal Register.