Get Ready for the Rulemaking!

As my colleague, Sarah Dash noted in her blog yesterday, the election results mean full steam ahead for the federal government and the states as they continue with the job of implementing the Affordable Care Act – and the ultimate success of the law will hinge on many decisions yet to be made. The federal agencies implementing health reform – the Departments of Health and Human Services, Labor and Treasury, and the Office of Personnel Management – now face the challenging task of issuing the necessary rules of the road for the insurance companies, employers and providers impacted by the law. And many state officials are waiting for the information they need to establish health insurance exchanges and move forward with the new insurance market rules.

The federal agencies will need to move quickly. Open enrollment for the health insurance exchanges is scheduled to start on October 1, 2013, less than 11 months from now. Insurers need time to develop their products, price them, and have them reviewed and approved by state departments of insurance. And exchanges need time to build their systems and test them.

As a result, now that the election is over and health reform is moving forward, we at CHIR are expecting a flurry of new regulations and guidance from the federal agencies over the coming days and weeks. Figuring out what rules are coming out when is an inexact science at best, but below are just some of the regulations and guidance we’ll be watching for and blogging about:

Insurance Market Rules

  • Proposed rules to implement the 2014 insurance market rules, such as requirements that insurers guarantee issue coverage and prohibitions on pre-existing condition exclusions. These might also address the law’s new standards for plans that provide incentives for wellness and healthy behaviors.
  • Proposed rules setting standards for essential health benefits and identifying states’ benchmark selections.
  • Rules regarding plans’ actuarial values, setting standards for implementation of the Affordable Care Act’s “precious metal” tiers, requiring plans to offer Bronze, Silver, Gold and Platinum level coverage.
  • A new rule on the review of insurers’ proposed premium rate increases.
  • A proposed rule from the U.S Office of Personnel Management regarding a Multi-State Plan program.

Exchange-related Rules and Guidance

  • Guidance for the evaluation of states’ readiness to establish a state-based exchange.
  • Guidance on the operation of federally facilitated exchanges and state-federal partnership exchanges.
  • Rules or guidance on the standards for Navigator programs and “in-person assistors.”
  • Rules or guidance on standards for the Small Business Health Options (SHOP) exchanges.

These rules will be critically important – for the insurance companies that will need to redesign their products, for the employers who must make decisions soon about coverage options for 2014, and for consumers who need to understand their new rights and responsibilities under health reform. The election results provided a clear signal to move forward – there’s a lot to do in very little time!

Be sure to check in with CHIRblog where we’ll update you on these rules and everything else you need to know about the “Implementing the Affordable Care Act.”