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CMS, IRS proposed rules address ACA exemptions, essential coverage

January 30, 2013

The Centers for Medicare & Medicaid Services and Internal Revenue Service today issued proposed rules for determining eligibility for exemption from the "shared responsibility" payment for not maintaining minimum essential coverage under the Patient Protection and Affordable Care Act. Among other provisions, CMS said its proposed rule clarifies that "individuals who would be eligible for Medicaid but for a state's choice not to expand Medicaid eligibility" will qualify for a hardship exemption. The proposed rule also provides standards for determining whether certain other types of health insurance coverage constitute minimum essential coverage, and procedures for sponsors to follow for a plan to be identified as minimum essential coverage. CMS will accept comments on its proposed rule through March 18. Comments on the IRS rule are due by May 2.