Patient Protection and Affordable Care Act; Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards
Federal Information & News Dispatch, Inc. |
SUMMARY: This proposed rule sets forth financial integrity and oversight standards with respect to Affordable Insurance Exchanges; Qualified Health Plan (QHP) issuers in Federally-facilitated Exchanges (FFEs); and States with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards with respect to agents and brokers. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Patient Protection and Affordable Care Act as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act.
EFFECTIVE DATE: To be assured consideration, comments must be received at one of the addresses provided below, no later than
ADDRESSES: In commenting, please refer to file code CMS-9957-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (please choose only one of the ways listed):
1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:
4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:
a. For delivery in
(Because access to the interior of the
b. For delivery in
If you intend to deliver your comments to the
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
SUPPLEMENTARY INFORMATION:
Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.
Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the
Electronic Access
This
Acronyms and Short Forms
Because of the many organizations and terms to which we refer by acronym in this proposed rule, we are listing these acronyms and their corresponding terms in alphabetical order below:
Affordable Care Act The Affordable Care Act of 2010 (which is the collective term for the Patient Protection and Affordable Care Act (Pub. L. 111-148) and the Health Care and Education Reconciliation Act (Pub. L. 111-152))
ALJ Administrative Law Judge
APTC Advance payments of the premium tax credit
ARF Allowable rating factor
AV Actuarial Value
CAHPS(R) Consumer Assessment of Healthcare Providers and Systems
CFR Code of Federal Regulations
CMP Civil money penalty
FEHB Federal Employees Health Benefits
FFE Federally-facilitated Exchange
FFE API Federally-facilitated Exchange application programming interface
FF-SHOP Federally-facilitated Small Business Health Options Program
GAAP Generally-accepted accounting principles
GAAS Generally accepted auditing standards
GAGAS Generally accepted governmental auditing standards
GAO United States Government Accountability Office
HIPAA Health Insurance Portability and Accountability Act of 1996 (Pub. L. 104-191)
IRS
MLR Medical Loss Ratio
PHS Act Public Health Service Act
PII Personally Identifiable Information
PRA Paperwork Reduction Act
QHP Qualified Health Plan
SHOP Small Business Health Options Program
The Code Internal Revenue Code of 1986
TIN Taxpayer Identification Number
Executive Summary
Starting on
Although many of the proposed provisions in this proposed rule would become effective by 2014, we do not believe that affected parties will have difficulty complying with the provisions by their effective dates, because most of the proposed standards are based on existing standards currently in effect in the private market, were previously proposed through the Blueprint process, discussed in agency-issued sub-regulatory guidance, or were discussed in the preambles to the Exchange Establishment Rule, /1/ Premium Stabilization Rule, /2/ and the HHS Notice of Benefit and Payment Parameters for 2014. /3/ In addition to general comments on the substance of the proposed provisions, we seek input on ways to implement these proposed policies to minimize burden.
FOOTNOTE 1 Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers, 77 FR 18310 (
FOOTNOTE 2 Patient Protection and Affordable Care Act; Standards Related to Reinsurance, Risk Corridors and Risk Adjustment, 77 FR 17220 (
--This is a summary of a
Proposed rule.
CFR Part: "45 CFR Parts 144, 147, 153, 155, and 156"
RIN Number: "RIN 0938-AR82"
Citation: "78 FR 37032"
Document Number: "CMS-9957-P"
Federal Register Page Number: "37032"
"Proposed Rules"
Copyright: | (c) 2013 Federal Information & News Dispatch, Inc. |
Wordcount: | 1435 |
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News