Keeping in mind the length of the Patient Protection and Affordable Care Act, we have separated our section-by-section analysis of the law from our basic summary of each title. If you keep reading this page, you will get a basic overview of the law and each title contained within it.
Center on Health Insurance Reforms Blogging about health insurance coverage, insurance markets, and how people are affected by insurance reform Welcome to CHIRblog, a blog focused Affordable health reforms act health insurance coverage, insurance markets, and how people are affected by insurance reform.
Our experts share a common mission: Among its many changes summarized here and here on the Health Affairs Blog, the proposed rule, Affordable health reforms act finalized, would defer a number of critical decisions to state policymakers.
As discussed regularly on CHIRblogstates have long been key decision makers when it comes to implementing or not implementing the ACA. The proposed rule would defer additional decision making and oversight to state insurance regulators. This blog highlights some of the major decisions that states would be tasked with under the proposed rule, including in the areas of essential health benefits, qualified health plan QHP certification standards, rate review, medical loss ratio MLR rules, and risk adjustment.
The proposed rule also makes a number of changes in areas where states, especially state-based marketplaces, have long played a regulatory role and have flexibility to exceed federal standards.
These include meaningful difference standards, standardized plan options, navigators, and special enrollment periods, among others. Although these provisions of the rule are not discussed here because HHS did not propose additional autonomy for states, states can continue to have or adopt policies that are more protective of consumers than federal standards.
Federal regulations directed states to select an EHB-benchmark plan for the plan year and again for the plan year.
Although 26 states ultimately defaulted to the largest small group plan, many studied their EHB-benchmark plan options at length to make an informed decision and states have made a variety of policy decisions regarding EHB implementation since then. It is within this context that HHS proposes to provide states with additional flexibility to define their EHB-benchmark plan for plan year and annually thereafter.
HHS outlines four options for states: To the extent a state re-defines its EHB benchmark plan under this proposal, however, the state must continue to defray the cost of any state-level benefit mandates adopted after December 31, In the proposed rule, HHS notes that the fourth option—selecting a new EHB-benchmark plan altogether—could be burdensome for states who would need to invest resources in assessing whether the new benchmark plan option meets new federal requirements, facilitating a public notice and comment period, collecting and submitting additional data to HHS, instructing insurers on how to make changes, and implementing new EHB-benchmark plans and limits such as converting dollar limits to non-dollar limits.
The proposed rule would require states to adopt reasonable notice and public comment requirements before making a change to the EHB-benchmark plan. However, HHS does not include any specific requirements, such as the length of a comment period or a public hearing, and would defer to states to develop a reasonable process.
States would also have to submit additional data when selecting EHB-benchmark plans; materials for plan year would be due in March Finally, states would have to make a familiar decision regarding whether to ban or limit benefit substitution.
Under current federal regulations, plans are allowed to substitute non-prescription drug benefits within each of the 10 EHB categories, but not between two categories. The proposed rule would allow plans to do both—to substitute non-prescription drug benefits both within and between EHB benefit categories so long as the benefit changes are actuarially equivalent.
States would continue to be responsible for enforcing these requirements and could prohibit benefit substitution altogether, limit it to substitution within EHB categories, or otherwise enforce these standards.
Qualified Health Plan Certification Standards. Consistent with previous federal rules issued in earlyHHS intends to further defer regulatory review and oversight to state insurance regulators for and beyond. For instance, HHS proposes to continue to shift oversight of network adequacy to the states despite significant state variation in this area.
In federally facilitated marketplace states, HHS proposes deferring to states on additional QHP certification areas—such as accreditation requirements, compliance reviews, and quality improvement strategy reporting—and requests comment on other areas of review where HHS could defer to states.
States could impose a lower filing threshold but would have to obtain permission from HHS to impose a threshold above 15 percent.
States with an effective rate review program could set different filing dates for insurers that offer QHPs and those that do not and could choose to post rate filing information on a rolling basis rather than all at once as is currently required. States would also largely be responsible for regulating student health insurance rates because HHS proposes to exempt student health insurance rates from rate review beginning with plan year States could decide to request an adjustment to the federal MLR in their state.
Although this option has been available to states since the phase-in of the market reforms, HHS proposes to dramatically simplify the waiver process. In particular, HHS proposes to reduce the amount and type of information that states would have to submit to seek a waiver.
This includes eliminating the requirement that the state describe their MLR standard and formula or provide detailed individual market enrollment and premium data. Although states would have to explain how their proposed MLR adjustment would help stabilize the individual market, they would no longer have to justify how they calculated their adjustment or how it would affect rebates.1 Application of Market Reform and other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain other Employer Healthcare Arrangements.
Our ‘Affordable Care Act’ Summary breaks down ObamaCare section by section. The ‘Affordable Care Act’ summary will give the most factual representation of the law by summarizing each of the Act’s 10 titles. Every title and every section of the ‘Affordable Care Act’ is packed with details (even the condensed version of the law is about pages long).
The Affordable Care Act contains comprehensive health insurance reforms and includes tax provisions that affect individuals, families, businesses, insurers, tax-exempt organizations and government entities.
Ensuring the Affordable Care Act Serves the American People. The Center for Consumer Information and Insurance Oversight (CCIIO) is charged with helping implement many reforms of the Affordable Care Act, the historic health reform bill that was signed into law March 23, ObamaCare is a nickname for The Patient Protection and Affordable Care Act of (sometimes called the Affordable Care Act, ACA, or PPACA for short), a health reform law signed on March 23, , by President Barack Obama.
Jan 02, · After Obama, Some Health Reforms May Prove Lasting. A transformation of the delivery of health care may be an enduring legacy for the president, even as Republicans plan to repeal the Affordable.