Key Aspect of SHOP Exchanges Delayed

On May 31, the U.S. Department of Health and Human Services (HHS) issued a final rule delaying the implementation of a significant portion of the Federal Small Business Health Options Program (SHOP) Exchanges. The SHOP Exchanges, established in the Patient Protection and Affordable Care Act (PPACA), are intended to allow small businesses employees access to several health insurance plans. BenefitMall provided information on the SHOP delay in April in a legislative alert

PCIP Program Continues to Endure Financial Shortages, States Being Asked to Absorb Excess Costs

Recent reports, and the fact that the federal Pre-Existing Condition Insurance Plan (PCIP) program stopped accepting new enrollees in February, indicate PCIP is encountering serious funding problems, a situation that could put more financial strain on states and threaten the availability of insurance premium subsidies for uninsured individuals with pre-existing conditions. The U.S. Health and Human Services Department (HHS) is now asking states to bear the burden of the cost overruns, but if the states are unwilling to pick up the expenses, cuts to benefits for high-risk individuals are likely to follow.

Proposed Rule Updates Role of Navigators, Non-Navigators in Exchanges

The Department of Health and Human Services (HHS) has released an interim final rule that clarifies the role of Navigator and non-Navigator assistance personnel employed by both state and federal health insurance Exchanges as established by the Patient Protection and Affordable Care Act (PPACA). The proposed rule was published in the April 5 Federal Register. 

Navigators are those deemed by PPACA to provide assistance to consumers interested in purchasing health insurance coverage through state-based Exchanges. The non-Navigator assistance personnel are designated to provide additional consumer assistance, education, and outreach functions beyond the role of the Navigators. 

HHS Issues New Rules on the Implementation of Health Insurance Reform

Earlier this month, the U.S. Department of Health and Human Services (HHS) released new proposed, final rules on a host of issues relating to the implementation of the Patient Protection and Affordable Care Act (PPACA). Many of these reforms will be implemented on January 1, 2014. The rule will be effective on April 30, 2013.

The rule, published on March 11, 2013, provides detail to a wide range of reforms under PPACA, covering additional explanations or updates to:

HHS Releases Draft Application for Individuals & Families as part of the Online Exchange Enrollment Process: Many Express Concerns about Complexity

Last week, the U.S. Department of Health and Human Services (HHS) released the draft paper application, and corresponding online version, to receive benefits through a state health benefits Exchange. 

The application, available here, has been criticized by many industry insiders who were hoping for a simple, straight forward application that would ease the burden of the individual mandate on consumers. Others are more supportive, stating that “this is the government’s first stab at simplifying a notoriously complicated process.”

PPACA Fails to Simplify Administrative Process

The Patient Protection and Affordable Care Act (PPACA) is failing to live up to a key promise that was made when the law was enacted in 2010 —simplifying the administrative process to obtain health insurance coverage through a state health benefits Exchange.

The U.S. Department of Health and Human Services (HHS) recently issued a draft of the paper application and a 60-page description of the online version earlier this week. While the White House has supported the law, claiming Exchanges, or “marketplaces,” will “help you find health insurance that fits your budget, with less hassle,” it is becoming increasingly clear that is not the case.

HHS Completes Initial Review of State-Based and Partnership Exchange Blueprints

Last week, the U.S. Department of Health and Human Services (HHS) announced the conditional approval of four states to operate partnership Exchanges. Iowa, Michigan, New Hampshire and West Virginia had declared their intention to build their respective Exchange systems in collaboration with HHS – an option available to states under the Patient Protection Affordable Care Act (PPACA) – but HHS had to review each state’s plan or “blueprint” for the Exchange before moving forward.

Exchange Deadline Passes: 50% of States Default to Federally-Facilitated Exchanges

As implementation of President Obama’s health insurance reform law continues, a major deadline has come and gone.

States were required to notify the U.S. Department of Health and Human Services (HHS) by Friday, February 15, if they planned to establish a state-based health benefits Exchange. If HHS did not receive notification, the state is deemed to default to a federally-run Exchange. Regardless of whether the state or federal government is in charge, the Patient Protection and Affordable Care Act (PPACA) requires that Exchanges be operational by October 1 of this year.

HHS Issues Final Rule on Essential Health Benefits

The Department of Health and Human Services (HHS) has released a 149-page final rule detailing the essential health benefits (EHB) requirements. Beginning in 2014, all new small group and individual market plans will be required to cover EHB categories. The rule largely codifies proposed rules that were released last November.  

HHS Secretary Kathleen Sebelius praised the rule, stating, “People all across the country will soon find it easier to compare and enroll in health plans with better coverage, greater quality and new benefits.”

Concerns Linger Whether PPACA Can Achieve Public Policy Goals

Although we often hear both from the supporters and critics of the Patient Protection and Affordable Care Act (PPACA), a rising chorus of concern is being heard almost daily now in major media outlets.  The news and analysis now is being driven by a more pragmatic and somber approach as many new programs and requirements will go in effect in 2014.  A recent opinion piece in The Wall Street Journal by Daniel P. Kessler, a professor at Stanford University, showcases this trend.