CMS Fact Sheet: 2015 Health Policy Standards

Washington, DC—(ENEWSPF)—March 5, 2014. Today the Administration is releasing comprehensive guidance for 2015 on key health law policies under the Affordable Care Act.  

This comprehensive release of regulations and policies responds to the concerns we’ve heard from families, states, businesses, health professionals, Congress, insurance commissioners, and insurers who want certainty on what’s coming as early as possible so that they can plan ahead. 

These policies, from the U.S. Department of Health and Human Services and the Treasury Department, implement the health care law in a common-sense way by continuing to smooth the transition for consumers and employers, recognizing that in many cases a one-size-fits-all approach doesn’t work best. 

Recognizing that consumers, employers, and insurers want to know how to plan and what to expect, the agencies are getting ahead by providing stakeholders with early information and the certainty that they need to plan for next year and, in some cases, beyond.  This comprehensive approach incorporates the flexibility that exists under the law and best practices at every opportunity.

Key provisions announced today include:

Simplifying and streamlining reporting requirements for employers (Treasury Department): While 96 percent of employers are not subject to ACA reporting requirements or the employer responsibility provision because they have fewer than 50 employees,  the requirements – to offer quality, affordable coverage to employees or make a payment – begin to phase in for the remaining four percent of employers in 2015.The final regulations released today will substantially streamline and simplify reporting requirements for employers, especially those that offer highly affordable coverage to their full-time employees and provide guidance to insurers for reporting the coverage they provide individuals.

Improving choices for individuals and small businesses (Department of Health and Human Services): In November 2013, HHS announced that States could allow insurers to offer current enrollees the option to renew their 2013 health plans in 2014, without change, allowing them to keep their plans.  HHS indicated that it would consider extending this transitional policy beyond 2014. Taking account the experience to date, today, HHS extended this transition policy for two years: to policy years beginning on or before October 1, 2016, giving states and issuers the option of allowing consumers to renew 2013 plans for two more years. This gives individuals and small businesses the choice of staying in their plan or joining a new Marketplace plan.  Additionally, the final rules expand the choices in small business Marketplace called SHOP, detailing its implementation in 2015.

Adjusting the premium stabilization programs to keep premiums affordable (Department of Health and Human Services): The Affordable Care Act includes several provisions to help ensure that premiums remain stable and affordable in the Health Insurance Marketplaces.  One program, the transitional reinsurance program, helps with high-cost patients.  The final rules improve the ability of this program to keep premiums affordable.  The reinsurance program is budget neutral.  Additionally, the temporary risk corridors program helps stabilize premiums when enrollees are much sicker – or much healthier – than expected. To account for the transitional policy, HHS is making an adjustment to the risk corridors program.  The Administration intends to operate the risk corridors program in a budget neutral manner, with payments in equaling payments out, while helping to ensure that prices remain affordable in 2015 and beyond.

For more information on policies from the Treasury Department see this fact sheet: www.treasury.gov/press-center/press-releases/Pages/jl2310.aspx

Link to regulation 1: https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-05050.pdf

Link to regulation 2: https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-05051.pdf

For more information on policies from the HHS and CMS see this fact sheet: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-sheets-items/2014-03-05-2.html

Link to Payment Parameters Final Regulation: https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-05052.pdf

Link to CMS Bulletin: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/transition-to-compliant-policies-03-06-2015.pdf

Source: hhs.gov