Federal Regulations
February 18, 2011
CMS Issues Interim Final Rule on Long-Term Care Facilities
The interim regulation amends the requirements that a long-term care (LTC) facility must meet in order to qualify to participate as a skilled nursing facility (SNF) under Medicare, or a nursing facility (NF) in the Medicaid program. These requirements implement Sec. 6113 of the ACA to ensure that, among other things, in the case of a LTC facility closure, the individuals serving as administrators of a SNF or NF provide written notification of the impending closure, as well as a plan for the relocation of residents
Effective Date: March 23, 2011
Comment Date: April 19, 2011
Link to Interim Final Rule
Link to Additional Information
December 1, 2010
HHS Issues New Medical Loss Ratio Regulations
HHS announced new medical loss ratio regulations implementing the medical loss ratio requirements for health insurance issuers under the ACA. The new rules that require health insurers spend at least 80% of premium dollars on direct care and quality improvement activities. These regulations certify and adopt the recommendations submitted by the National Association of Insurance Commissioners (NAIC).
Effective Date: January 1, 2011
Comment Date: January 31, 2011
Link to the Interim Final Rule
Link to Additional Information
July 30, 2010
Interim Final Rule on Pre-Existing Condition Plan
The ACA establishes a temporary high risk health insurance pool program, the Pre-Existing Condition Insurance Plan (PCIP) to provide health insurance coverage to currently uninsured individuals with pre-existing conditions until 2014. The regulations establish standards necessary for the administration of the program and clarify certain issues not otherwise specified in the statute. These include, but are not limited to, required and excluded benefits; eligibility and enrollment requirements; and funding allocation.
Effective Date: July 30, 2010
Comment Date: September 28, 2010
Link to the Interim Final Rule
Link to Additional Information
July 23, 2010
Interim Final Rules on the Internal Claims and Appeals and External Review Processes
These regulations, issued by the Departments of HHS, Labor and the Treasury, will standardize both an internal process and an external process that patients can use to appeal decisions made by their health plan.
Effective Date: September 21, 2010
Comment Date: September 21, 2010
Link to the Interim Final Rule
Link to Additional Information
July 14, 2010
Interim Final Rules for Coverage of Preventive Services under the ACA
The Departments of HHS, Labor and Treasury issued interim final regulations requiring new plans and issuers to cover certain preventive services without any cost-sharing for the enrollee when delivered by in-network providers. The interim final regulations do not apply to grandfathered plans and issuers. More information, including the items and services that must be covered under this regulation in accordance with the recommendations of the United States Preventive Services Task Force (USPSTF), can be found by following the links below.
Effective Date: September 17, 2010
Comment Date: September 17, 2010
Link to the Interim Final Rule
Link to Additional Information
June 28, 2010
Interim Final Rule on Patient’s Bill of Rights
The regulations prohibit new group health plans and health insurance issuers in both the group and individual markets from imposing pre-existing condition exclusions on children under 19 for the first plan year, or policy year in the individual market, beginning on or after September 23, 2010. These regulations apply to grandfathered group health plans and group health insurance coverage, but do not apply to grandfathered individual health insurance coverage that was in existence on March 23, 2010.
Effective Date: August 27, 2010
Comment Date: August 27, 2010
Link to the Interim Final Rule
Link to Additional Information
June 17, 2010
Interim Final Rules for Grandfathered Health Plans under the ACA
The new regulation requires grandfathered health plans to provide certain consumer protections as required in the ACA in order to allow individuals and businesses to keep their current plans, while ensuring stability and flexibility to insurers and businesses that offer health insurance coverage as the system adapts to the Exchanges in 2014.
Effective Date: June 14, 2010
Comment Date: August 16, 2010
Link to the Interim Final Rule
Link to Additional Information
May 13, 2010
Interim Final Rule on Dependent Coverage of Children up to Age 26
The ACA requires plans and issuers that offer dependent coverage to make the coverage available until a child reaches the age of 26, for both married and unmarried children. This rule applies to all plans in the individual market, to new employer plans, and to existing employer plans unless the adult child has another offer of employer-based coverage. Beginning in 2014, children up to age 26 can stay on their parent’s employer plan even if they have another offer of coverage through an employer.
Effective Date: July 12, 2010
Comment Date: August 11, 2010
Link to the Interim Final Rule
Link to Additional Information
May 5, 2010
Interim Final Rule on the Early Retiree Reinsurance Program
The Early Retiree Reinsurance Program, established under the ACA, provides reimbursement to employer and union sponsors of participating employment-based plans for a portion of the cost of health benefits for early retirees and their spouses, surviving spouses, and dependents. The Secretary will reimburse sponsors for certain claims between $15,000 and $90,000. For information on the program, including how to apply, frequently asked questions and educational materials for sponsors, please visit the links below.
Effective Date: June 1, 2010
Comment Date: June 4, 2010
Link to the Interim Final Rule
Link to Additional Information
May 3, 2010
Interim Final Rule on Health Care Reform Insurance Web Portal Requirements
The ACA requires the establishment of a website through which individuals and small businesses can obtain information about the insurance coverage options that may be available to them in their state. The interim final rule adopts the categories of information that will be collected and displayed via the website, and the data HHS will require from issuers and request from states, associations, and high risk pools in order to create the content.
Effective Date: May 10, 2010
Comment Date: June 4, 2010
Link to the Interim Final Rule
Link to Additional Information