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HHS releases proposed ACA-related insurance rules

November 20, 2012

The Department of Health and Human Services today released three proposed rules and other guidance related to many of the insurance provisions contained in the Patient Protection and Affordable Care Act. The essential health benefits rule spells out the administration's proposed core set of mandatory covered health benefits, and provides guidance on benefits required by the ACA that are not typically found in current employer benefit plans, as well as a standard method for computing the actuarial value of each health plan for consumer comparison purposes. The Centers for Medicare & Medicaid Services also issued a letter to state Medicaid directors on the coordination of the essential health benefits rule and the Medicaid program. In addition, a health insurance market proposed rule would codify an ACA provision prohibiting insurers from discriminating against individuals because of a pre-existing or chronic condition, among other changes. A third rule, released with the departments of Labor and Treasury, focuses on implementing and expanding employer use of incentives under their wellness programs while protecting consumers from unfair underwriting practices that could reduce benefits based on health status. HHS also issued a notice recognizing the National Committee for Quality Assurance and URAC as accrediting entities for qualified health plan certification, as well as a proposed rule for the process to be used for applications by other accrediting bodies. The proposed rule also provides a timetable for accreditation of QHPs. HHS officials said additional guidance on the federally facilitated insurance exchange will be released soon.