HHS published a final rule on March 11, 2013 to establish additional regulatory requirements regarding ACA health insurance provisions that go into effect in 2014. Specifically, the rule provides detailed standards for the permanent risk adjustment methodology, a transitional reinsurance program, and a temporary risk corridors program from 2014 to 2016, which are intended to stabilize premiums as new consumer protections take effect in 2014. In addition, the rule clarifies the administration of advance payments of the premium tax credit and certain cost-sharing reductions. The rule also implements user fees for health insurance issuers participating in a federally-facilitated Exchange, and amends medical loss ratio (MLR) program rules to require issuers include premium stabilization amounts in MLR and rebate calculations. Moreover, the rule establishes a number of standards for the Small Business Health Options Program (SHOP), which will allow small employers to offer employees a variety of qualified health plans. HHS also published a separate proposed rule on March 11 outlining a transitional policy for certain operations of the SHOP designed to ensure market stability in 2014 and conform SHOP enrollment periods to those in the broader group health insurance market. Comments on the proposed rule will be accepted until April 1, 2013. Finally, HHS also issued an interim final rule with comment period to build on the final benefit and payment parameters for 2014. The interim final rule aligns risk corridors calculations with the single risk pool provision, and sets standards permitting issuers of qualified health plans to use an alternate methodology to calculate the value of certain cost-sharing reductions. Comments will be accepted until April 30, 2013.
