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GBS_6555 
Regulatory Guidance 

In this section, you will find guidance issued on major Healthcare Reform topics. Below are active links that direct you to the appropriate regulatory language (agency).

  


View By Year

2014

Date

Guidance Issued

Agency

Authority

Jan. 16, 2014

Early Retiree Reinsurance Program: Common Questions regarding recordkeeping updated [www.errp.gov]

HHS

ACA §1102

Jan. 14, 2014

High Risk Pool Program: transitional coverage extended through March 31, 2014, for individuals enrolled in a federally-run PCIP if they have not selected a new plan; PCIP Coverage [www.pcip.gov]

HHS

ACA §1101

Jan. 10, 2014

Health Coverage-Related Payments: volunteer hours of volunteer firefighters and emergency medical personnel at governmental or tax-exempt organizations generally will not be counted when determining full-time employees or full-time equivalents under forthcoming employer shared responsibility final regulations; Treasury Notes Blog [www.treasury.gov]

Treasury

Code §4980H

Jan. 9, 2014

Cost Sharing; Preventive Health Services; Expatriate Plans; Wellness Programs; Fixed Indemnity Insurance; Mental Health and Substance Use Disorder Parity: FAQs about Affordable Care Act Implementation (Part XVIII) and Mental Health Parity Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §§2705, 2707, 2713, 2719, 2726, 2791; Code §9812 and ERISA §712

Jan. 6, 2014

Medical Loss Ratios: final regulations for MLR computation for taxable years after December 31, 2013, for Blue Cross or Blue Shield organizations and others seeking to qualify for §833 tax treatment; T.D. 9651, 79 Fed. Reg. 755 (1/7/14)

IRS, Treasury

Code §833; PHSA §2718

Jan. 3, 2014

Individual Mandate; Health Insurance Exchanges: Questions and Answers on Options Available for Consumers with Cancelled Policies [www.cms.gov/cciio]

HHS

ACA §1302(e); Code §5000A

2013

Date

Guidance Issued

Agency

Authority

Dec. 31, 2013

Health Care Premium Tax Credit; Health Insurance Exchanges: “Verification of Household Income and Other Qualifications for the Provision of Affordable Care Act Premium Tax Credits and Cost-Sharing Reductions,” report required by P.L. 113-46, §1001 [www.cms.gov/cciio]

HHS

P.L. 113-46

Code §36B; ACA §1402

Dec. 30, 2013

Medical Loss Ratios: Question and Answer Regarding the Medical Loss Ratio Reporting and Rebate Requirements; CCIIO Technical Guidance (CCIIO 2013-0004) [www.cms.gov/cciio]

HHS

PHSA §2718

Dec. 30, 2013

Health Insurance Exchanges: State-based Marketplaces (SBMs): Frequently Asked Questions on the State-based Marketplace Annual Reporting Tool (SMART) [www.cms.gov/cciio]

HHS

ACA §1313

Dec. 24, 2013

Individual Mandate; Minimum Essential Coverage: corrections to T.D. 9632 final regulations; 78 Fed. Reg. 78255 (12/26/13) and 78 Fed. Reg. 78256 (12/26/13)

IRS

Treasury

Code §5000A

Dec. 23, 2013

Health Insurance Exchanges: federally-run Exchanges provide an additional day for enrollment—HHS states that website systems were programmed to accept sign-ups through December 24, 2013, for an effective coverage date of January 1, 2014; HHS offers case-by-case assistance to people who could not finish online applications by December 24 [www.healthcare.gov]

HHS

ACA §1311

Dec. 20, 2013

Excepted Benefits: limited excepted benefits proposed to be amended effective for plan years starting in 2015; through at least 2014, dental and vision benefits and EAP benefits that meet the conditions of the proposed regulations are considered to qualify as excepted benefits; REG-143172-13, 78 Fed. Reg. 77632 (12/24/13)

DOL
HHS
Treasury

Code §9831; ERISA §732; PHSA §§2722, 2763

Dec. 20, 2013

Health Insurance Exchanges: final notice of recognized accrediting entity for qualified health plan certification; 78 Fed. Reg. 77470 (12/23/13)

HHS

ACA §1311

Dec. 19, 2013

Individual Mandate; Health Insurance Exchanges: guidance discusses Options Available for Consumers with Cancelled Policies and announces eligibility for a temporary hardship exemption and for enrollment in catastrophic coverage for individuals with a cancelled individual market policy; letter from Secretary of HHS to Senator Warner [http://www.cms.gov/cciio]

HHS

Letter

ACA §1302(e); Code §5000A

Dec. 19, 2013

Early Retiree Reinsurance Program: guidance discusses Options Available for Consumers with Cancelled Policies and announces eligibility for a temporary hardship exemption and for enrollment in catastrophic coverage for individuals with a cancelled individual market policy; letter from Secretary of HHS to Senator Warner [http://www.cms.gov/cciio]

HHS

ACA §1102

Dec. 18, 2013

Health Insurance Exchanges: federal funding methodology proposed for program year 2015 of Basic Health Program; 78 Fed. Reg. 77399 (12/23/13)

HHS

ACA §1331

Dec. 18, 2013

Health Insurance Exchanges: cost-sharing reduction reconciliation guidance for qualified health plan issuers; Choice of Methodology for Cost-Sharing Reduction Reconciliation (12/13/13) [www.cms.gov/cciio]

HHS

ACA §1402

Dec. 17, 2013

Small Employer Health Care Tax Credit: transition relief allows tax credit for health plan years beginning in 2014 for otherwise eligible small employers located in certain counties in Washington and Wisconsin that do not have qualified health plans available in 2014; Notice 2014-6, 2014-2 I.R.B.

IRS

Code §45R

Dec. 12, 2013

High Risk Pool Program: transitional coverage is available through January 31, 2014, for individuals enrolled in a federally-run PCIP if they have not selected a new plan; PCIP Coverage for January 2014 [www.pcip.gov]

HHS

ACA §1101

Dec. 12, 2013

Health Insurance Exchanges; Health Insurance Market Reforms: interim final rule allows individuals to select a qualified health plan until December 23, 2013, for an effective coverage date of January 1, 2014, allows state exchanges to select a different date, and establishes a related policy regarding payment of the initial premium; 78 Fed. Reg. 76212 (12/17/13)

HHS

ACA §1311; PHSA §2702

Dec. 11, 2013

Health Insurance Exchanges; Claims and Appeals: federal external review rules apply to Multi-State Plan Program (MSPP) plans effective December 13, 2013; 78 Fed. Reg. 75581 (12/12/13)

OPM

ACA §1334; PHSA §2719

Dec. 6, 2013

Health Insurance Exchanges: Frequently Asked Questions on the use of 1311 funding for Change Orders and Congressional Inquiries [www.cms.gov/cciio]

HHS

ACA §1311

Dec. 2, 2013

Health Insurance Exchanges: SHOP Update [www.regtap.info]

HHS

ACA §1311

Nov. 27, 2013

Health Insurance Exchanges: changes to federally-facilitated SHOP enrollment process for 2014 require small employers to use direct enrollment, i.e., enroll employees in coverage through an agent, broker or insurer; online applications delayed to November 2014; HealthCare.gov limited to information on plan options; Blog: A Direct New Path to SHOP Marketplace Coverage; FAQs [www.hhs.gov/healthcare]

HHS

FAQs

ACA §1311

Nov. 26, 2013

Health Insurance Providers Fee: final rules regarding annual fee due from covered entities beginning September 30, 2014, for net premiums written for health insurance for U.S. health risks for the preceding calendar year; Treas. Regs. Part 57, T.D. 9643, 78 Fed. Reg. 71476 (11/29/13)

IRS,
Treasury

ACA §§9010, 10905; HCERA §1406

Nov. 26, 2013

Health Insurance Providers Fee: guidance on the time and manner for submitting Form 8963, notifying covered entities of their preliminary fee calculation, and submitting a corrected Form 8963 for the error correction process, and on the time for notifying covered entities of their final fee calculation, Notice 2013-76, 2013-51 I.R.B.

IRS

ACA §§9010, 10905; HCERA §1406

Nov. 26, 2013

Health Insurance Providers Fee: guidance on income tax treatment of amounts a covered entity collects from policyholders to offset the cost of the annual fee, Rev. Rul. 2013-27, 2013-51 I.R.B.

IRS

ACA §§9010, 10905; HCERA §1406

Nov. 26, 2013

Net Investment Income Tax: final rules regarding the general application and the computation of the 3.8% Medicare contribution tax on unearned income of individuals, estates and trusts; T.D. 9644, 78 Fed. Reg. 72394 (12/2/13); proposed rules regarding additional modifications to the tax computation; REG-130843-13, 78 Fed. Reg. 72451 (12/2/13)

IRS,
Treasury


IRS,
Treasury

Code §1411

Nov. 26, 2013

Additional Medicare Tax: final rules for the withholding, computation, reporting, and payment of Additional Medicare Tax on wages and self-employment income, and for interest-free adjustments and refund claims; T.D. 9645, 78 Fed. Reg. 71468 (11/29/13)

IRS,
Treasury

Code §§1401, 3101, 3102

Nov. 25, 2013

Health Insurance Exchanges; Health Care Premium Tax Credit: proposed guidance on Notice of Benefit and Payment Parameters for 2015 and proposed details for: the risk adjustment, reinsurance, and risk corridors programs; user fees for a federally-facilitated Exchange; SHOPs; cost-sharing parameters and reductions; the annual open enrollment period for 2015; and the actuarial value calculator; 78 Fed. Reg. 72322 (12/2/13)

HHS

ACA §§1311, 1321, 1341-1343, 1402-1412

Nov. 21, 2013

Health Insurance Market Reforms: list of Standard Notices for Transition to ACA Compliant Policies required for transitional relief allowing issuers to continue non-grandfathered coverage that would otherwise be cancelled for individuals and small businesses [www.cms.gov/cciio]

HHS

PHSA §§2701-2707, 2709

Nov. 20, 2013

Fair Health Insurance Premiums; Premium Review Process: Procedural Guidance Regarding State Reporting for Plan or Policy Years Beginning in 2015 related to state-specific rating and risk pooling standards [www.cms.gov/cciio]

HHS

PHSA §§2701, 2794

Nov. 14, 2013

Health Insurance Market Reforms: transitional policy permits issuers to continue coverage for individuals and small businesses that would otherwise be cancelled and considers coverage that is renewed for a policy year starting between January 1, 2014, and October 1, 2014, and associated group health plans of small businesses to not be out of compliance with specified market reforms if conditions are met; CMS Letter to Insurance Commissioners [www.cms.gov/cciio]

HHS

PHSA §§2701-2707, 2709

Nov. 14, 2013

Health Insurance Exchanges: notice describes overall Quality Rating System (QRS) framework for rating qualified health plans offered through an Exchange; 78 Fed. Reg. 69418 (11/19/13)

HHS

ACA §1311

Nov. 8, 2013

Mental Health and Substance Use Disorder Parity: final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, incorporating Affordable Care Act requirements; T.D. 9640, 78 Fed. Reg. 68240 (11/13/13); FAQs (Part XVII) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

FAQs

PHSA §§2719, 2726; Code §9812 and ERISA §712

Nov. 4, 2013

Health Insurance Exchanges: Q&A guidance for Third Party Payments of Premiums for Qualified Health Plans in the Marketplaces [www.cms.gov/cciio]

HHS

ACA §1321

Oct. 31, 2013

Minimum Essential Coverage; Health Insurance Exchanges: Process for Obtaining Recognition as Minimum Essential Coverage for types of coverage not statutorily specified and not designated through regulation as minimum essential coverage [www.cms.gov/cciio]

HHS

Code §5000A; ACA §§1311, 1411

Oct. 28, 2013

Minimum Essential Coverage; Health Insurance Exchanges: Shared Responsibility Provision Question and Answer permits individuals enrolling in a plan through the Exchange during the initial open enrollment period to claim on their tax return a hardship exemption from the shared responsibility payment for months before the effective date of coverage [www.cms.gov/cciio]

HHS

Code §5000A; ACA §§1311, 1411

Oct. 24, 2013

Health Insurance Exchanges; Health Insurance Market Reforms: final rules governing: financial integrity and oversight standards for Exchanges, Qualified Health Plan issuers in federally-facilitated Exchanges, and states related to the operation of risk adjustment and reinsurance programs; standards for special enrollment periods; and standards related to risk corridors and cost-sharing reduction reconciliation; 78 Fed. Reg. 65046 (10/30/13)

HHS

ACA §§1311, 1321, 1341-1343, 1402-1413; PHSA §§2702, 2703

Oct. 24, 2013

Health Insurance Exchanges; Health Insurance Market Reforms: final rules governing: financial integrity and oversight standards for Exchanges, Qualified Health Plan issuers in federally-facilitated Exchanges, and states related to the operation of risk adjustment and reinsurance programs; standards for special enrollment periods; and standards related to risk corridors and cost-sharing reduction reconciliation; 78 Fed. Reg.65045 (10/30/13)

HHS

ACA §§1311, 1321, 1341-1343, 1402-1413; PHSA §§2702, 2703

Oct. 23, 2013

Health Insurance Exchanges: Exchange establishment grants awards list [www.cms.gov/cciio]

HHS

ACA §1311

Oct. 23, 2013

Health Insurance Exchanges: alterations to Health Insurance Exchanges (HIX) Program system of records; 78 Fed. Reg. 63211 (10/23/13)

HHS

5 USC §552a; ACA §§1311, 1321, 1411-1413

Oct. 17, 2013

Health Care Premium Tax Credit; Health Insurance Exchanges: Continuing Appropriations Act, 2014 (P.L. 113-46), §1001, requires that HHS Secretary certify to Congress that Exchanges verify applicants' eligibility for credit and cost-sharing subsidies and report by January 1, 2014, on verification procedures [www.gpo.gov]

Public
Law

Code §36B; ACA §1402

Oct. 3, 2013

Early Retiree Reinsurance Program: Reminder Regarding Plan Sponsor's Responsibilities for Phase Down of ERRP Secure Website [www.errp.gov]

HHS

ACA §1102

Oct. 3, 2013

Health Insurance Exchanges: Federally Facilitated Marketplace Enrollment Operational Policy & Guidance [www.cms.gov/cciio]

HHS

ACA §1311

Oct. 2, 2013

Health Insurance Exchanges: CMS technical assistance portal FAQs — Federally-facilitated Marketplace for SHOP: Frequently Asked Questions (10/2/13) about premium calculations and employer and employee contributions[www.regtap.info]

HHS

ACA §1311

Sept. 30, 2013

Health Insurance Exchanges: memorandum clarifies that offices of the Members of Congress are eligible to participate in a SHOP regardless of the size and offering requirements for qualified employers in a SHOP Exchange[www.cms.gov/cciio]

HHS

ACA §1312(d)(3)(D)

Sept. 30, 2013

Health Insurance Exchanges: final rule amending the Federal Employees Health Benefits (FEHB) Program regulations so that Members of Congress and congressional staff cannot purchase health benefits plans for which OPM may contract under chapter 89 because the plans are not created under PPACA or offered through the Exchanges; 78 Fed. Reg. 60653 (10/2/13)

OPM

ACA §1312(d)(3)(D)

Sept. 27, 2013

Health Insurance Exchanges; Health Care Premium Tax Credit: “Guidance on Internal Revenue Ruling 2013-17 and Eligibility for Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions” provides for same Exchange eligibility for same-sex and opposite-sex spouses [www.cms.gov/cciio]

HHS

Code §36B; ACA §1402

Sept. 26, 2013

Health Insurance Exchanges: revised Health Insurance Marketplace consumer application for health coverage and instructions released for individuals—short form (instructions), families (instructions) and individuals who do not need financial assistance (instructions) [www.cms.gov/cciio]

HHS

Individual Short Form (Instructions)

Families (Instructions)

Individual/Families – No financial assistance (Instructions)

ACA §§1311(d)(2), 1312(a)(1)

Sept. 26, 2013

Health Insurance Exchanges: SHOP functions in federally-facilitated Exchange states will be available in November 2013; small employers may begin the application process and get an overview of available plans and premiums starting October 1, and start coverage on January 1, 2014 for enrollment by December 15, 2013; CMS News Release (9/26/13) [www.cms.gov]

HHS

ACA §1311

Sept. 20, 2013

Health Insurance Exchanges: proposed rules for states to establish a Basic Health Program beginning January 1, 2015; 78 Fed. Reg. 59122 (9/25/13)

HHS

ACA §1331

Sept. 16, 2013

Wellness Programs; Health Insurance Exchanges: CMS technical assistance portal FAQs — Federally-facilitated Marketplace for SHOP: Frequently Asked Questions (9/13/13) about avoidance of tobacco premium rating surcharge [www.regtap.info]

HHS

PHSA §2705

Sept. 13, 2013

Health Care Premium Tax Credit; Multiemployer Plans: Treasury Department letter to Chair of Committee on Ways & Means responding to whether the premium tax credit is available to individuals covered by a multiemployer plan

IRS,
Treasury

Code §36B

Sept. 13, 2013

Annual and Lifetime Limits; Preventive Health Services; Cafeteria Plans: Application of Market Reform and Other Provisions of the Affordable Care Act to HRAs, Health FSAs, and Certain Other Employer Healthcare Arrangements; Notice 2013-54, 2013-40 I.R.B. 287; EBSA Technical Release 2013-03; CMS bulletin (9/16/13) [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §§2711, 2713; Code §§36B, 125(f)(3), 5000A

Sept. 12, 2013

Premium Review Process: 2013 Annual Rate Review Report issued [aspe.hhs.gov]

HHS

PHSA §2794

Sept. 11, 2013

Notice of Exchange Coverage Options: FAQ on Notice of Coverage Options states that no fine or penalty applies for failing to provide the notice [www.dol.gov/ebsa]

DOL

Fair Labor Standards Act §18B

Sept. 9, 2013

Preventive Health Services: notice clarifies that high deductible health plans may provide PHSA-required preventive care health services without a deductible; Notice 2013-57, 2013-40 I.R.B. 293

IRS

Code §223(c)(2); PHSA §2713

Sept. 5, 2013

Reporting Health Insurance Coverage: proposed regulations regarding information reporting related to health insurance coverage by employers, issuers and other providers of health coverage; REG-136630-12, 78 Fed. Reg. 54996 (9/9/13), and REG-132455-11, 78 Fed. Reg. 54986 (9/9/13)

IRS,
Treasury


IRS,
Treasury

Code §§6055, 6056

Sept. 4, 2013

Notice of Exchange Coverage Options; Waiting Period Limitation: FAQs (Part XVI) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

Fair Labor Standards Act §18B; PHSA §2708

Aug. 29, 2013

Health Insurance Exchanges; Health Insurance Market Reforms: final rules governing: Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases; standards with respect to a state's operation of the Exchange and SHOP; 78 Fed. Reg. __ (8/30/13)

HHS

ACA §§1311-1313, 1321, 1341, 1342, 1343, 1402-1413; PHSA §§2701, 2702, 2703

Aug. 27, 2013

Individual Mandate; Minimum Essential Coverage: final regulations provide guidance on the requirement that individuals maintain minimum essential coverage and “shared responsibility” liability for not having the health coverage; T.D. 9632, 78 Fed. Reg. __ (8/30/13)

IRS,
Treasury

Code §5000A

Aug 23, 2013

Small Employer Health Care Tax Credit: proposed regulations provide guidance on tax credit for small businesses and tax-exempt organizations for periods after December 31, 2013; REG-113792-13, 78 Fed. Reg. 52719 (8/26/13)

IRS,
Treasury

Code §45R

Aug 13, 2013

Disclosure of Taxpayer Return Information: final rules for IRS disclosures under Code §6103(l)(21) to HHS of information relevant to premium tax credits, cost-sharing subsidies, Medicaid, CHIP, or basic health programs, and HHS's disclosures to Exchanges; comments requested; T.D. 9628, 78 Fed. Reg. 49367 (8/14/13)

IRS,
Treasury

Code §6103

Aug 9, 2013

Health Insurance Exchanges: online training for agents and brokers wanting to operate within federally-facilitated Exchanges [www.cms.gov/cciio]

HHS

ACA §1312(e)

Aug 7, 2013

Health Insurance Exchanges: proposed rule to amend the Federal Employees Health Benefits (FEHB) Program regulations for Members of Congress and congressional staff cannot purchase health benefits plans for which OPM may contract under chapter 89 because the plans are not created under PPACA or offered through the Exchanges; 78 Fed. Reg. 48337 (8/8/13)

OPM

ACA §1312(d)(3)(D)

Aug 5, 2013

Health Insurance Exchanges: Frequently Asked Questions on Health Insurance Marketplaces and Income Verification [www.cms.gov/cciio]

HHS

ACA §§1411-1413

Aug 1, 2013

Nondiscrimination Laws: Request for information regarding health programs and activities under ACA §1557, including examples of discrimination, programs and activities to cover, impacts of discrimination, access for individuals with limited English proficiency, sex discrimination issues, access to electronic and information technology, and compliance and enforcement approaches; 78 Fed. Reg. 46558 (8/1/13)

HHS

ACA §1557

July 24, 2013

Claims and Appeals; Summary of Benefits and Coverage: 2013 Culturally and Linguistically Appropriate Services (CLAS) County Data lists counties and non-English languages in which claims notices and SBC must be provided upon request; Updated Instructions for Calculating County Level Estimates [www.cms.gov/cciio]

HHS


HHS

PHSA §2719

July 12, 2013

Health Insurance Exchanges: final rules on standards for Navigators and non-Navigator assistance personnel for federally-facilitated and state partnership Exchanges and state-based Exchanges receiving Exchange establishment grants; 78 Fed. Reg. 42824 (7/17/13); CCIIO Guidance on Certified Application Counselor Program for the Federally-Facilitated Marketplace including State Partnership Marketplaces and draft application [www.cms.gov/cciio]

HHS


HHS

HHS

ACA §1311(i)

July 9, 2013

Health Coverage-Related Payments; Reporting Health Insurance Coverage: questions and answers on transition relief for 2014 regarding employer shared responsibility and related information reporting by employers, issuers and other providers of health coverage; Notice 2013-45, 2013-31 I.R.B. 116

IRS

Code §§4980H, 6055, 6056

July 9, 2013

Governmental Plans: active HIPAA opt-out elections for self-funded, nonfederal governmental plans [www.cms.gov/cciio]

HHS

PHSA §2722

July 9, 2013

Insurer, Employer Reporting Requirements; Employer Shared Responsibility Provisions: Transition Relief for 2014 Under §§ 6055 (§ 6055 Information Reporting), 6056 (§ 6056 Information Reporting) and 4980H (Employer Shared Responsibility Provisions)

IRS

Code §§ 6055, 6056, 4980H

July 5, 2013

Health Insurance Exchanges: final amendments related to eligibility notices and appeals for Medicaid, CHIP, and Exchanges (45 CFR Parts 155, 156; 42 CFR); 78 Fed. Reg.(7/15/13)

HHS

ACA §§1411, 1413

July 2, 2013

Health Coverage-Related Payments; Reporting Health Insurance Coverage: White House and Treasury Department announce plans to delay until 2015 employer shared responsibility payment and related information reporting by employers and issuers; [www.treasury.gov]

Treasury

Code §§4980H; 6055, 6056

July 2, 2013

Medical Loss Ratios: Question and Answer Regarding the Medical Loss Ratio Reporting and Rebate Requirements; CCIIO Technical Guidance [www.cms.gov/cciio]

HHS

PHSA §2718

June 28, 2013

Health Care Premium Tax Credit: proposed regulations would amend rule regarding Exchange reporting to the IRS to provide details for reporting of information related to the health insurance premium tax credit; REG-140789-12, 78 Fed. Reg. __ (7/2/13)

IRS
Treasury

Code §36B

June 28, 2013

Preventive Health Services: final rules issued for religious exemptions and accommodations for women's contraceptives; T.D. 9624, 78 Fed. Reg. __ (7/2/13); HRSA guidelines modified; CCIIO Technical Guidance extends temporary enforcement safe harbor; self-certification form (EBSA Form 700) issued; model Notice of Availability of Separate Payments for Contraceptive Services issued [www.cms.gov/cciio; www.hrsa.gov]

Treasury
DOL
HHS


Form 700

HHS Notice

PHSA §2713

June 26, 2013

Health Care Premium Tax Credit; Minimum Essential Coverage: guidance for determining whether an individual is eligible for coverage in a qualified health plan subsidized by the premium tax credit; Notice 2013-41, 2013-29 I.R.B. __

IRS

Code §36B

June 26, 2013

Individual Mandate: transition relief for employees and related individuals eligible to enroll in eligible employer-sponsored health plans for non-calendar plan years that begin in 2013 and end in 2014; Notice 2013-42, 2013-29 I.R.B. __

IRS

Code §5000A

June 26, 2013

Minimum Essential Coverage; Health Insurance Exchanges: final rules regarding Exchange functions in determining eligibility for exemptions from the individual shared responsibility payment and miscellaneous minimum essential coverage provisions; 78 Fed. Reg. __ (7/1/13); CCIIO Guidance on Hardship Exemption Criteria and Special Enrollment Periods [www.cms.gov/cciio]

HHS

HHS

Code §5000A; ACA §§1311, 1411

June 24, 2013

Health Insurance Exchanges: relaunched HealthCare.gov contains educational information for the Health Insurance Marketplace [www.healthcare.gov]

HHS

June 14, 2013

Health Insurance Exchanges; Health Insurance Market Reforms: proposed rules governing: financial integrity and oversight standards for Exchanges, Qualified Health Plan issuers in federally-facilitated Exchanges, and states related to the operation of risk adjustment and reinsurance programs; advance payments of the premium tax credit and cost-sharing reductions; additional standards for agents and brokers; premium stabilization; and clarifications for market standards; 78 Fed. Reg. 37032 (6/19/13); letter to NAIC

HHS

HHS
Letter

ACA §§1311-1313, 1321, 1341, 1342, 1343, 1402-1413; PHSA §§2701, 2702, 2703

June 6, 2013

Fees on Self-Insured Health Plan Sponsors and Health Insurance Policy Issuers: Form 720 updated for Patient-Centered Outcomes Research Fee due by July 31 of calendar year immediately following last day of plan/policy year [www.irs.gov]

IRS

Code §§4375, 4376, 4377

May 31, 2013

Health Insurance Exchanges: Employer Application and Employee Application for SHOP health coverage; press release [www.cms.gov/cciio]

HHS

ACA §1311

May 31, 2013

Health Insurance Exchanges: amendments finalized to Small Business Health Options Program (SHOP), including special enrollment periods for qualified employees and their dependents and a transitional policy regarding employees' choice of qualified health plans; 78 Fed. Reg. 33233 (6/4/13)

HHS

ACA §§1311, 1312, 1411-1413

May 31, 2013

Health Insurance Exchanges: Federal Marketplace Progress Fact Sheet updated [www.cms.gov/cciio]

HHS

ACA §§1311, 1312, 1411-1413

May 30, 2013

Medical Loss Ratios; Fixed Indemnity Insurance: Question and Answer Regarding the Requirement that Issuers of Certain Health Insurance Coverage sold as Fixed Indemnity Insurance submit an annual Medical Loss Ratio (MLR) report to the Secretary; CCIIO Technical Guidance (CCIIO 2013-0002) [www.cms.gov/cciio]

HHS

PHSA §2718

May 29, 2013

Wellness Programs: final rules to increase maximum permissible reward offered through group health plans' health-contingent wellness programs and extend application of HIPAA nondiscrimination provisions to individual market; T.D. 9620, 78 Fed. Reg. 33158 (6/3/13)

IRS,
DOL,
HHS

PHSA §2705, Code §9802, ERISA §702

May 17, 2013

High Risk Pool Program: interim final rule sets payment rates for covered services furnished to individuals enrolled in HHS-administered PCIP program beginning with covered services furnished on June 15, 2013, 78 Fed. Reg. 30218 (5/22/13)

HHS

ACA §1101

May 14, 2013

Health Insurance Exchanges: Frequently Asked Questions on Health Insurance Marketplaces [www.cms.gov/cciio]

HHS

ACA §1311

May 13, 2013

Health Insurance Exchanges: Frequently Asked Questions on Essential Community Providers [www.cms.gov/cciio]

HHS

ACA §1311

May 13, 2013

Health Insurance Exchanges: Frequently Asked Questions on Allowable Uses of Section 1311 Funding for States in a State Consumer Partnership Marketplace and for States in a State Partnership Marketplace or in States with a Federally-Facilitated Marketplace [cciio.cms.gov]

HHS

ACA §1311

May 10, 2013

Health Insurance Exchanges: Small Business Health Options Program (SHOP)-Only Marketplace FAQs [www.cms.gov/cciio]

HHS

ACA §§1311, 1312, 1411-1413

May 10, 2013

Medical Loss Ratios: proposed regulations for MLR computation for taxable years after December 31, 2013, for Blue Cross or Blue Shield organizations and others seeking to qualify for §833 tax treatment; REG-126633-12, 78 Fed. Reg. 27873 (5/13/13)

IRS

Code §833; PHSA §2718

May 8, 2013

Notice of Exchange Coverage Options: temporary guidance setting October 1, 2013 deadline and notifying of model notices and updated model COBRA election notice, EBSA Technical Release 2013-02

DOL
HHS
Treasury

Fair Labor Standards Act §18B

May 6, 2013

Health Insurance Exchanges: Model Language for Individual Market Renewal Notices [www.cms.gov/cciio]

HHS

ACA §1311

May 1, 2013

Health Insurance Exchanges: Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces [cciio.cms.gov]

HHS

ACA §§1311(i), 1312(e)

Apr. 30, 2013

Health Care Premium Tax Credit: proposed regulations provide guidance on determining whether health coverage under an employer-sponsored plan provides minimum value; REG-125398-12, 78 Fed. Reg. 25909 (5/3/13)

IRS
Treasury

Code §36B

Apr. 30, 2013

Health Insurance Exchanges: revised Health Insurance Marketplace consumer application for health coverage released for individuals—short form, families, and individuals who do not need financial assistance; submissions begin October 1, 2013 [cciio.cms.gov]

HHS
Individual
Families
Individual - No Assistance

ACA §§1311(d)(2), 1312(a)(1)

Apr. 29, 2013

Provider Nondiscrimination; Clinical Trials; Annual and Lifetime Limits; Transparency Reporting: FAQs (Part XV) about the Affordable Care Act Implementation www.dol.gov/ebsa

DOL
HHS
Treasury

PHSA §§2706, 2709, 2711, 2715A

Apr. 26, 2013

Health Insurance Market Reforms; Association Plans: Questions and Answers Related to the Health Insurance Market Reforms [cciio.cms.gov]

HHS

PHSA §§2701, 2702, 2741, 2791

Apr. 23, 2013

Summary of Benefits and Coverage: FAQs (Part XIV) about the Affordable Care Act Implementation www.dol.gov/ebsa

DOL
HHS
Treasury

PHSA §2715

Apr. 19, 2013

Early Retiree Reinsurance Program: final dates to correct data inaccuracies, submit reimbursement requests, and submit reopening requests; CMS Notice, 78 Fed. Reg. 23936 (4/23/13)

CMS

ACA §1102

Apr. 5, 2013

Medical Loss Ratios: Questions and Answers Regarding the Medical Loss Ratio Reporting and Rebate Requirements; CCIIO Technical Guidance (CCIIO 2013-0001) [cciio.cms.gov]

HHS

PHSA §2718

Apr. 4, 2013

Consumer Operated and Oriented Plan Program: Q&As related to Consumer Operated and Oriented Plan Program Contingency Fund [cciio.cms.gov]

HHS

ACA § 1322

Apr. 3, 2013

Health Insurance Exchanges: proposed rules on standards for Navigators and non-Navigator assistance personnel for federally-facilitated and state partnership Exchanges and state-based Exchanges receiving Exchange establishment grants; 78 Fed. Reg. 20581 (4/5/13)

HHS

ACA § 1311(i)

Apr. 1, 2013

Deduction Limitation for Remuneration for Services to Health Insurance Providers: proposed guidance on application of deduction limit that would apply to taxable years that begin after 2012; proposal may be relied upon until final regulations are issued and does not affect the applicability of Notice 2011-2; Treas. Prop. Regs. § 1.162-31, REG-106796-12, 78 Fed. Reg. 19950 (4/2/13)

IRS

Code §
162(m)(6)

Mar. 29, 2013

Medical Loss Ratios: MLR annual reporting procedures for issuers for the 2012 MLR reporting year; CMS Memorandum [cciio.cms.gov]

HHS

PHSA § 2718

Mar. 18, 2013

Waiting Period Limitation: proposed rules implementing the 90-day waiting period limitation and conforming rules regarding HIPAA portability provisions to reflect Affordable Care Act market reforms; REG-122706-12, 78 Fed. Reg. 17313 (3/21/13)

IRS,
DOL,
HHS

PHSA § 2708

Mar. 15, 2013

Claims and Appeals: Extension to January 1, 2016, of transition period during which issuer compliance with applicable state external review process that meets temporary NAIC-similar process standards will be deemed compliance with regulation's minimum standards, EBSA Technical Release 2013-01 (and CMS Technical Release 2013-01) [cciio.cms.gov]

DOL,
HHS

PHSA §2719

Mar. 8, 2013

Expatriate Plans: FAQs (Part XIII) regarding Affordable Care Act Implementation: transitional relief for plans with plan years ending on or before December 31, 2015 [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §§2701 et seq.

Mar. 1, 2013

Health Insurance Exchanges; Medical Loss Ratios; Health Care Premium Tax Credit: final Notice of Benefit and Payment Parameters for 2014 with details for: the risk adjustment, reinsurance, and risk corridors programs; user fees for a federally-facilitated Exchange; a federally-facilitated SHOP; cost-sharing reductions; advance payments of the §36B premium tax credit; and the medical loss ratio program; 78 Fed. Reg. 15410 (3/11/13)

HHS

ACA §§1311, 1321, 1341-1343, 1402-1412; PHSA §2718

Mar. 1, 2013

Health Insurance Exchanges: interim final rule building upon standards in Notice of Benefit and Payment Parameters for 2014; 78 Fed. Reg. 15541 (3/11/13)

HHS

ACA §§1342, 1402, 1412

Mar. 1, 2013

Health Insurance Exchanges: proposed amendments to Small Business Health Options Program (SHOP), including triggering events and special enrollment periods for qualified employees and their dependents and a transitional policy regarding employees' choice of qualified health plans; comments requested; 78 Fed. Reg. 15553 (3/11/13)

HHS

ACA §§1311, 1312, 1411- 1413

Mar. 1, 2013

Health Insurance Exchanges: final rule to implement the Multi-State Plan Program (MSPP) so that health insurance issuers will offer at least two multi-state plans (MSPs) on each Exchange; 45 CFR Pt. 800, 78 Fed. Reg. 15560 (3/11/13)

OPM

ACA §1334

Mar. 1, 2013

Health Insurance Providers Fee: proposed regulations regarding annual fee due from covered entities beginning September 30, 2014, for net premiums written for health insurance for U.S. health risks for the preceding calendar year; Treas. Prop. Regs. Part 57, REG-118315-12, 78 Fed. Reg. 14034 (3/4/13)

Treasury

ACA §§9010, 10905; HCERA §1406

Feb. 28, 2013

Multiple Employer Welfare Arrangements (MEWAs): final rules on ex parte cease and desist orders and summary seizure orders, DOL Regs. §§2560.521-1 et seq. and Part 2571, 78 Fed. Reg. 13797 (3/1/13)

DOL

ERISA §521

Feb. 28, 2013

Multiple Employer Welfare Arrangements (MEWAs): final amendments to reporting rules to address the reporting obligations of MEWAs that are ERISA plans, DOL Regs. §2520.101-2, 78 Fed. Reg. 13781 (3/1/13); Notice of 2012 Form M-1 revisions and delayed filing deadlines and revisions of Annual Information Return/Reports, 78 Fed. Reg. 13897 and 13899 (3/1/13), respectively; Online Filing System [www.dol.gov/ebsa]

DOL

ERISA §101(g)

Feb. 27, 2013

Early Retiree Reinsurance Program: reissued guidance on complying with the maintenance of contribution requirement associated with the prohibition on using reimbursements as general revenue [www.errp.gov]

HHS

ACA §1102

February 22, 2013

Employer Retaliation: interim final rules provide OSHA procedures for handling whistleblower complaints, DOL Regs. §§1984.100 et seq., 78 Fed. Reg. __ (2/27/13)

DOL

FLSA §18C

February 22, 2013

Health Insurance Market Reforms; Premium Review Process: final rules on fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, catastrophic plans and rate review program; RIN 0938-AR40, 78 Fed. Reg. __ (2/27/13)

HHS

PHSA §§2701, 2702, 2703, 2723, 2794; ACA §§1302, 1312

February 20, 2013

Cost Sharing; Preventive Services: FAQs (Part XII) regarding Affordable Care Act Implementation (http://www.dol.gov/ebsa/)

DOL
HHS
Treasury

PHSA §§2707, 2713

February 20, 2013

Health Insurance Exchanges; Essential Health Benefits: final rule establishing standards for exchanges and health insurance issuers related to coverage of essential health benefits, actuarial value and accreditation; RIN 0938-AR03, 78 Fed. Reg. __ (2/25/13)

HHS

ACA §§1302, 1311; PHSA §2707

February 16, 2013

High Risk Pool Program: federally-run PCIP suspends acceptance of new enrollment applications; states accept enrollment applications through March 2 [pcip.gov]

HHS

ACA §1101

February 1, 2013

Preventive Health Services: proposed rules would amend rules that provide women contraceptive coverage without cost sharing by altering religious employer exemption criteria and establishing accommodations for non-profit eligible organizations with religious objections to contraceptive coverage; REG-120391, 78 Fed. Reg. 8456 (2/6/13)

IRS
DOL
HHS

PHSA §2713

January 30, 2013

Individual Mandate; Minimum Essential Coverage: proposed regulations provide guidance on the requirement that individuals maintain minimum essential coverage and “shared responsibility” liability for not having the health coverage; REG-148500-12, 78 Fed. Reg. 7314 (2/1/13); Questions and Answers on the Individual Shared Responsibility Provision [www.irs.gov]

IRS, Treasury

Code §5000A

January 30, 2013

Health Care Premium Tax Credit: final regulations provide guidance on determining affordability when individuals related to the employee are eligible to enroll in an employer-sponsored plan; T.D. 9611, 78 Fed. Reg. 7264 (2/1/13)

IRS, Treasury

Code §36B

January 30, 2013

Health Insurance Exchanges: proposed amendments related to eligibility for exemptions and miscellaneous minimum essential coverage provisions (45 CFR Parts 155 and 156); 78 Fed. Reg. 7348 (2/1/13)

HHS

ACA §§1311(d)(4), 1411

January 25, 2013

Prescription Drug Benefits: HHS Bulletin on Employer Prescription Drug Coverage that Supplements Medicare Part D Coverage provided through an Employer Group Waiver Plan [cciio.cms.gov]

HHS

42 USC §1395w-132

January 24, 2013

Affordable Care Act Implementation: Part XI – Frequently Asked Questions. (http://www.dol.gov/ebsa/)

DOL

ACA § § 1512, 2711, 2717, PHSA § 2791

January 22, 2013

Health Insurance Exchanges: Proposed amendments related to eligibility notices and appeals for Medicaid, CHIP, and Exchanges (45 CFR Part 155; 42 CFR); 78 Fed. Reg. 4593 (1/22/13)

HHS

ACA § § 1411, 1413

January 3, 2013

Health Insurance Exchanges: Guidance on State Partnership Exchanges [cciio.cms.gov]

HHS

ACA § 1321

2012

Date

Guidance Issued

Agency

Authority

Dec. 28, 2012

Health Coverage-Related Payments: proposed regulations providing guidance on the shared responsibility for employers regarding employee health coverage generally incorporate Notice 2012-58 and many provisions of earlier notices, with modifications, and propose guidance on additional issues; employer reliance permitted pending the issuance of final regulations or other guidance; Treas. Prop. Regs. §§54.4980H-1 et seq., REG-138006-12, 77 Fed. Reg. __ (1/2/13)

IRS, Treasury

Code §4980H

Dec. 10, 2012

Health Insurance Exchanges: HHS letter to territories about Exchange establishment and operational standards, elections to not establish an Exchange, Exchange-related tax provisions, funding allocations, and application of Medicaid-related eligibility provisions [cciio.cms.gov]

HHS
Territories
Letter
FAQs

ACA §§ 1311-1313, 1323

Dec. 5, 2012

Fees on Self-Insured Health Plan Sponsors and Health Insurance Policy Issuers: final guidance on fees imposed by PPACA on issuers and self-insured plan sponsors to fund the Patient-Centered Outcomes Research Trust Fund; T.D. 9602, 77 Fed. Reg. 72721 (12/6/12)

IRS, Treasury

Code § § 4375, 4376, 4377

Dec. 3, 2012

Early Retiree Reinsurance Program: updated CMS guidance on use of ERRP funds, correcting inaccuracies, and notice of program [www.errp.gov]

HHS

ACA § 1102

Nov. 30, 2012

Net Investment Income Tax: proposed rules implementing 3.8% Medicare contribution tax on unearned income of individuals, estates and trusts; REG-130507-11, 77 Fed. Reg. 72612 (12/5/12)

IRS

Code § 1411

Nov. 30, 2012

Additional Medicare Tax: proposed rules for the withholding, computation, reporting, and payment of Additional Medicare Tax on wages and self-employment income, and for interest-free adjustments and refund claims; REG-130074-11, 77 Fed. Reg. 72268 (12/5/12)

IRS

Code § § 1401, 3101, 3102

Nov. 30, 2012

Health Insurance Exchanges; Medical Loss Ratios; Health Care Premium Tax Credit: draft Notice of Benefit and Payment Parameters proposes details and parameters for: the risk adjustment, reinsurance, and risk corridors programs; user fees for a federally-facilitated Exchange; a federally-facilitated SHOP; cost-sharing reductions; advance payments of the § 36B premium tax credit; and the medical loss ratio program; 77 Fed. Reg. 73118 (12/7/12)

HHS

ACA § § 1311, 1321, 1341-1343, 1402-1412; PHSA § 2718

Nov. 30, 2012

Health Insurance Exchanges: proposed rule to implement the Multi-State Plan Program (MSPP) so that health insurance issuers will offer at least two multi-state plans (MSPs) on each Exchange; Prop. 45 CFR Pt. 800, 77 Fed. Reg. 72582 (12/5/12)

OPM

ACA § 1334

Nov. 20, 2012

Wellness Programs: proposed rules to increase maximum permissible reward offered through group health plans' wellness programs and extend application of HIPAA nondiscrimination provisions to individual market; REG-122707-12, 77 Fed. Reg. 70620 (11/26/12)

IRS,
DOL,
HHS

Code § 9802,
PHSA § 2705

Nov. 20, 2012

Health Insurance Market Reforms; Premium Review Process: proposed rules on fair health insurance premiums, guaranteed availability, guaranteed renewability, risk pools, catastrophic plans and rate review program; RIN 0938-AR40, 77 Fed. Reg. 70584 (11/26/12)

HHS

PHSA § § 2701, 2702, 2703, 2723, 2794; ACA § § 1302, 1312

Nov. 20, 2012

Health Insurance Exchanges; Essential Health Benefits: proposed rule establishing standards for exchanges and health insurance issuers related to coverage of essential health benefits, actuarial value and accreditation; RIN 0938-AR03, 77 Fed. Reg. 70644 (11/26/12)

HHS

ACA § 1311

Nov. 20, 2012

Health Insurance Exchanges: final notice of recognized accrediting entities for qualified health plan certification; 77 Fed. Reg. 70163 (11/23/12)

HHS

ACA § 1311

Nov. 16, 2012

Health Insurance Exchanges: Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges revised [cciio.cms.gov]

HHS

ACA § 1102

Nov. 16, 2012

Early Retiree Reinsurance Program: guidelines for submitting sensitive information, i.e., protected health information (PHI) and personally identifiable information (PII) [www.errp.gov]

HHS

ACA § 1311

Nov. 15, 2012

Health Insurance Exchanges: letter from Secretary of HHS to governors extending deadline for letter of intent regarding operation of state-based Exchange [www.healthcare.gov]

HHS

ACA § 1311

Nov. 9, 2012

Health Insurance Exchanges: letter from Secretary of HHS to Governors extending deadlines for Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges [www.healthcare.gov]

HHS

ACA § 1311

Nov. 9, 2012

Health Insurance Exchanges: FAQs regarding approval process for Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges [cciio.cms.gov]

HHS

ACA § 1311

Nov. 9, 2012

Health Insurance Exchanges: FAQs regarding Exchange Establishment Cooperative Agreement Funding [cciio.cms.gov]

HHS

ACA § 1311

September 27, 2012

Health Insurance Exchanges: state-by-state status of exchange establishment grants [www.healthcare.gov]

HHS

ACA §1311

September 11, 2012

Premium Review Process: 2012 Annual Rate Review Report issued [www.healthcare.gov]

HHS

PHSA §2794

August 31, 2012

Health Coverage-Related Payments: safe harbor methods that employers may use to determine which employees are treated as full-time employees under the employer responsibility provisions; Notice 2012-58, 2012-41 I.R.B. __

IRS

Code §4980H

August 31, 2012

Waiting Period Limitation: temporary guidance regarding the 90-day waiting period limitation issued and remains in effect at least through 2014; Notice 2012-59, 2012-41 I.R.B. __; DOL Technical Release 2012-02; CCIIO Bulletin

IRS,
DOL,
HHS

PHSA §2708

August 24, 2012

Consumer Assistance Program: fact sheet on how states are using funding [www.healthcare.gov]

HHS

PHSA §2793

August. 17, 2012

Governmental Plans; Claims and Appeals: Technical Guidance for Non-Federal Governmental Plans provides enforcement safe harbor for content of Adverse Benefit Determination and Final Internal Adverse Benefit Determination [cciio.cms.gov]

HHS

PHSA §2719

August 15, 2012

Preventive Health Services: revised CCIIO Technical Guidance on temporary enforcement safe harbor until August 1, 2013, regarding coverage of contraceptive services without cost sharing by nonprofit employers who, based on religious beliefs, do not provide some or all services [cciio.cms.gov]

HHS

PHSA §2713

August 14, 2012

Health Insurance Exchanges: Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges [cciio.cms.gov]

HHS

ACA §1311

August 7, 2012

Summary of Benefits and Coverage: FAQs (Part X) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §2715

August 6, 2012

Nondiscrimination Laws: Questions and Answers on Section 1557 of the Affordable Care Act [http://www.hhs.gov/ocr]

HHS

ACA §1557

July 18, 2012

Essential Health Benefits: final rule establishing (1) standards for data collection from certain issuers to support the definition of essential health benefits and (2) a process for the recognition of accrediting entities that will certify qualified health plans, 45 CFR Part 156, 77 Fed. Reg. 42658 (7/20/12)

HHS

ACA §§1302, 1311

July 17, 2012

Medical Loss Ratios: Questions and Answers Regarding the Medical Loss Ratio Reporting and Rebate Requirements; CCIIO Technical Guidance (CCIIO 2012-005) [cciio.cms.gov]

HHS

PHSA §2718

July 2, 2012

Health Insurance Exchanges; Essential Health Benefits: Essential Health Benefits: List of the Largest Three Small Group Products by State (7/3/12) [cciio.cms.gov]

HHS

ACA §1302

June 29, 2012

Claims and Appeals: overview of HHS-Administered Federal External Review Process for Health Insurance Coverage [cciio.cms.gov]

HHS

PHSA §2719

June 28, 2012

Individual Mandate: In a 5-4 opinion, U.S. Supreme Court upholds individual mandate as within Congress's taxing power, stating that ACA's “requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax”; National Federation of Independent Business v. Sebelius, No. 11-393 (U.S. 6/28/12)

SCOTUS

Code §5000A

June 18, 2012

Health Insurance Exchanges: Notice soliciting input on publicly-available domains, instruments, and measures for use in establishing enrollee satisfaction survey system, 77 Fed. Reg. 37409 (6/21/12)

HHS

ACA §1311

June 11, 2012

Medicare Tax: Questions and Answers for the Additional Medicare Tax [www.irs.gov]

IRS

Code §3101

June 1, 2012

Essential Health Benefits: proposed rule to establish: (1) standards for data collection from certain issuers to support the definition of essential health benefits; and (2) a process for the recognition of accrediting entities that will certify qualified health plans, 45 CFR Part 156, 77 Fed. Reg. 33133 (6/5/12)

HHS

ACA §§1302, 1311

May 24, 2012

Medical Loss Ratios: Questions and Answers Regarding the Medical Loss Ratio Reporting Form; CCIIO Technical Guidance (CCIIO 2012-003) [cciio.cms.gov]

HHS

PHSA §2718

May 18, 2012

Health Care Premium Tax Credit: final regulations provide guidance for individuals who enroll in qualified health plans through insurance Exchanges and claim premium tax credit under §36B; T.D. 9590, 77 Fed. Reg. 30377 (5/23/12)

IRS, Treasury

Code §36B

May 18, 2012

Health Insurance Exchanges: General Guidance on Federally-facilitated Exchanges (5/16/12) [cciio.cms.gov]

HHS

ACA §1321

May 18, 2012

Health Insurance Exchanges: Draft Blueprint for Approval of Affordable State-based and State Partnership Insurance Exchanges (5/16/12) [cciio.cms.gov]

HHS

ACA §1311

May 16, 2012

Health System Measurement Project: HHS website tracks federal government data on U.S. health system indicators, such as access to care, cost and affordability, and health information technology, including data on employer-sponsored health insurance [aspe.hhs.gov]

HHS

 

May 16, 2012

Health Insurance Exchanges: correction to final rule for standards related to temporary reinsurance program (45 CFR Part 153); 77 Fed. Reg. 29235 (5/17/12)

HHS

ACA §1341

May 15, 2012

Medical Loss Ratios: correcting amendments to December 2010 interim final rules; 77 Fed. Reg. 28788 (5/16/12)

HHS

PHSA §2718

May 14, 2012

Medical Loss Ratios: final rule on notice of MLR information required from issuers when MLR standard is met or exceeded for 2011; 45 CFR Part 158; 77 Fed. Reg. 28790 (5/16/12); Medical Loss Ratio Information notice [cciio.cms.gov]

HHS

 

HHS

PHSA §2718

May 11, 2012

Summary of Benefits and Coverage: FAQs (Part IX) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §2715

April 27, 2012

Disclosure of Taxpayer Return Information: Proposed rules for IRS disclosures under Code §6103(l)(21) to HHS of information relevant to premium tax credits, cost-sharing subsidies, Medicaid, CHIP, or basic health programs, and HHS's disclosures to Exchanges; comments requested; REG-119632-11, 77 Fed. Reg. 25378 (4/30/12)

IRS

Code §6103

April 27, 2012

Stop Loss Coverage: request for information on the use of stop loss insurance by group health plans and their plan sponsors, with a focus on the prevalence and consequences of stop loss insurance at low attachment points; 77 Fed. Reg. 25788 (5/1/12)

DOL
HHS
Treasury

 

April 26, 2012

Reporting Health Insurance Coverage: Comments requested on reporting requirements for issuers, government agencies, employers sponsoring self-insured plans, and other persons that provide minimum essential coverage and for applicable large employers subject to employer responsibility requirements under Code §4980H; Notices 2012-32, 2012-20 I.R.B. 910, and 2012-33, 2012-20 I.R.B. 912

IRS

 

IRS

Code §§6055; 6056

April 26, 2012

Health Coverage-Related Payments; Health Care Premium Tax Credit: Possible approaches for determining whether an employer-sponsored plan provides minimum value; comments requested; Notice 2012-31, 2012-20 I.R.B. 906

IRS

Code §§36B; 4980H

April 26, 2012

Health Care Premium Tax Credit: Bulletin proposes strategies for Verification of Access to Employer-Sponsored Coverage; comments requested [cciio.cms.gov]

HHS

ACA §1411; Code §36B

April 20, 2012

Medical Loss Ratios: Questions and Answers Regarding the Medical Loss Ratio Regulation; CCIIO Technical Guidance (CCIIO 2012-002) [cciio.cms.gov]

HHS

PHSA §2718

April 12, 2012

Fees on Self-Insured Health Plan Sponsors and Health Insurance Policy Issuers: proposed guidance on fees imposed by PPACA on issuers and self-insured plan sponsors to fund the Patient-Centered Outcomes Research Trust Fund; REG-136008-11, 77 Fed. Reg. 22691 (4/17/12)

IRS, Treasury

Code §§4375, 4376, 4377

April 3, 2012

Medical Loss Ratios: MLR annual reporting procedures for issuers for the 2011 MLR reporting year; reports due June 1, 2012, CMS Memorandum (3/30/12) [cciio.cms.gov]

HHS

PHSA §2718

April 2, 2012

Medical Loss Ratios: FAQs regarding federal tax consequences of MLR rebates [www.irs.gov]

IRS

PHSA §2718

April 2, 2012

Prescription Drug Benefits: rules modified for PPACA and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA); coverage offered through employer group waiver plans (EGWPs), other than basic prescription drug coverage, excluded from definition of Medicare Part D supplemental benefits beginning January 1, 2013; 77 Fed. Reg. 22072 (4/12/12)

HHS

PHSA §2718

March 19, 2012

Summary of Benefits and Coverage: FAQs (Part VIII) regarding Affordable Care Act Implementation; during first year of applicability, no penalties imposed on plans and issuers working diligently and in good faith to provide the required SBC content in an appearance that is consistent with the final regulations [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §2715

March 16, 2012

Preventive Health Services: advance notice of proposed rulemaking on alternative ways to fulfill the preventive services requirements for contraceptive coverage when health coverage is sponsored or arranged by a religious organization that objects to the coverage and is not exempt from rules requiring it; 77 Fed. Reg. 16501 (3/21/12)

IRS
DOL
HHS

PHSA §2713

March 16, 2012

Student Health Insurance Coverage: final rule addressing applicability of guaranteed availability and renewability, annual limits, preventive services, choice of health care provider, and medical loss ratio requirements for policy years beginning on or after July 1, 2012; 77 Fed. Reg. 16453 (3/21/12)

HHS

ACA §1560(c); PHSA §§2711, 2713, 2718, 2719A, 2741, 2742

March 16, 2012

Health Insurance Exchanges: final state and health insurance issuer standards related to temporary reinsurance, temporary risk corridors, and permanent risk adjustment programs (45 CFR Part 153); 77 Fed. Reg.17220 (3/23/12); see also final and interim final CMS changes to Medicaid and CHIP eligibility to align with Exchange requirements and §36B credit, 77 Fed. Reg. 17144 (3/23/12) (42 CFR Parts 431, 435, 457)

HHS

 

HHS

ACA §§1321, 1341-1343

March 12, 2012

Health Insurance Exchanges: final and interim final rules for establishment of Exchanges and Qualified Health Plans; Exchange standards for employers (45 CFR Parts 155, 156, 157), effective May 29, 2012; 77 Fed. Reg. 18310 (3/27/12)

HHS

ACA §§1301-1304, 1311-1313, 1321, 1322, 1331, 1334, 1402, 1411-1413

March 9, 2012

Claims and Appeals; Summary of Benefits and Coverage: 2012 Culturally and Linguistically Appropriate Services (CLAS) County Data lists counties and non-English languages in which claims notices and SBC must be provided upon request [cciio.cms.gov]

HHS

PHSA §2719

February 24, 2012

Essential Health Benefits: Actuarial Value and Cost-Sharing Reductions Bulletin provides guidance on HHS's intended approach to defining actuarial value for qualified health plans and other non-grandfathered coverage in the small group and individual markets under ACA §1302(d)(2) and to implementing cost-sharing reductions under ACA §1402; comments requested [cciio.cms.gov]

HHS

ACA §§1302, 1402

February 22, 2012

Waivers for State Innovation: final rules for application, review, and reporting procedures for states to receive a waiver and to create their own plans to implement health care reform; 77 Fed. Reg. 11700 (2/27/12)

Treasury, HHS

ACA §1332

February 21, 2012

Health Insurance Exchanges; Essential Health Benefits: Frequently Asked Questions on Essential Health Benefits Bulletin provides additional guidance on HHS's intended approach to defining EHBs [cciio.cms.gov]

HHS

ACA §1302

February 16, 2012

Medical Loss Ratios: sample notices and

HHS

PHSA §2718

February 10, 2012

Preventive Health Services: interim rule on preventive care for women finalized; T.D. 9578, 77 Fed. Reg. 8725 (2/15/12); CCIIO Technical Guidance on temporary enforcement safe harbor for certain employers, group plans and group issuers regarding coverage of contraceptive services without cost sharing [cciio.cms.gov]

IRS
DOL
HHS

HHS

PHSA §2713

February 10, 2012

Medical Loss Ratios: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule and payments to clinical risk-bearing entities; CCIIO Technical Guidance (CCIIO 2012-001) [cciio.cms.gov]

HHS

PHSA §2718

February 9, 2012

Summary of Benefits and Coverage: final rules for disclosure of the SBC and the uniform glossary, effective beginning on the first day of the first open enrollment period (or plan year, for new eligibility and special enrollment) that begins on or after September 23, 2012; T.D. 9575 (Treas. Regs. §54.9815-2715), DOL Regs. §2590.715-2715, 45 CFR §147.200, 77 Fed. Reg. 8668 (2/14/12); SBC template with instructions and sample language, 77 Fed. Reg. 8706 (2/14/12)

Treasury,
DOL,
HHS

Treasury,
DOL,
HHS

PHSA §2715

February 9, 2012

Health Coverage-Related Payments; Waiting Period Limitation; Automatic Enrollment: Frequently asked questions from employers, and approaches being considered by agencies; Notice 2012-17, 2012-9 I.R.B. 430; EBSA Technical Release 2012-01; CCIIO bulletin

IRS
DOL
HHS

Code §4980H; PHSA §2708; Fair Labor Standards Act §18A

February 7, 2012

Consumer Operated and Oriented Plan Program: procedures for issuing determination letters and rulings on the exempt status of qualified nonprofit health insurance issuers described in Code §501(c)(29); Rev. Proc. 2012-11, 2012-7 I.R.B. 368

IRS

Code §501(c)(29)

January 26, 2012

Health Insurance Exchanges; Essential Health Benefits: Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State [cciio.cms.gov]

HHS

ACA §1302

January 20, 2012

Preventive Health Services: contraceptive coverage delayed until August 1, 2013, for nonprofit employers (other than religious employers) who, based on religious beliefs, do not provide service [www.hhs.gov]

HHS

PHSA §2713

January 3, 2012

Form W-2 Reporting: Revised interim guidance on reporting the aggregate cost of employer-sponsored health coverage at least for 2012 Forms W-2; transitional relief for certain employers and certain types of coverage; Notice 2012-9, 2012-4 I.R.B. 315

IRS

Code §6051(a)(14)

2011

Date

Guidance Issued

Agency

Authority

Dec. 16, 2011

Health Insurance Exchanges; Essential Health Benefits: bulletin discussing employer plan surveys and outlining proposed regulatory approach to defining essential health benefits; request for comments [cciio.cms.gov]

HHS

ACA §1302

Dec. 8, 2011

Consumer Operated and Oriented Plan Program: final rules for governance of the CO-OP program and the terms for loan awards (45 CFR §§156.500 to 156.520); 76 Fed. Reg. 77392 (12/13/11)

HHS

ACA §1322

Dec. 5, 2011

Multiple Employer Welfare Arrangements (MEWAs): proposed rules on ex parte cease and desist orders and summary seizure orders, DOL Prop. Regs. §§2560.521-1 et seq. and Part 2571, 76 Fed. Reg. 76235 (12/6/11)

DOL

ERISA §521

Dec. 5, 2011

Multiple Employer Welfare Arrangements (MEWAs): proposed amendments to reporting rules to address the reporting obligations of MEWAs that are ERISA plans, DOL Prop. Regs. §2520.101-2, 76 Fed. Reg. 76222 (12/6/11); notice of proposed revision of Annual Information Return/Report and notice of proposed revision of Form M-1, 76 Fed. Reg. 76252 and 76250 (12/6/11), respectively; proposed Form M-1 revisions [www.dol.gov/ebsa]

DOL

 

DOL

DOL

ERISA §101(g)

Dec. 2, 2011

Medical Loss Ratios:final rules on disclosures and reporting, including the treatment of “mini-med” and expatriate policies, determining de minimis rebates, calculating MLR and providing premium rebates, effective January 1, 2012, with request for comments; 45 CFR Part 158, 76 Fed. Reg. 76574 (12/7/11)

HHS

PHSA §2718

Dec. 2, 2011

Medical Loss Ratios; Governmental Plans: interim final rule on distribution of rebates by issuers in group markets for nonfederal governmental plans, effective January 1, 2012, with request for comments; 45 CFR §158.242(b), 76 Fed. Reg. 76596 (12/7/11)

HHS

PHSA §2718

Dec. 2, 2011

Medical Loss Ratios: DOL guidance on MLR rebates for ERISA-covered group health plans—implications when distributions are plan assets, EBSA Technical Release 2011-04 [www.dol.gov/ebsa]

DOL

PHSA §2718

Nov. 21, 2011

Health Care Premium Tax Credit: 3% Withholding Repeal and Job Creation Act, P.L. 112-56, amends Code §36B definition of modified adjusted gross income used in defining household income

P.L. 112-56

Code §36B

Nov. 18, 2011

Health Care Reform Insurance Web Portal: Health insurance finder tool, which displays information about insurance plans so that consumers can compare options, provides private coverage options for small businesses [www.healthcare.gov]

HHS

ACA §1103(a)

Nov. 17, 2011

Summary of Benefits and Coverage; Mental Health and Substance Use Disorder Parity: FAQs (Part VII) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §2715; Code §9812 and ERISA §712

Oct. 14, 2011

Long-Term Care: Community Living Assistance Services and Supports (CLASS) program implementation suspended [www.healthcare.gov]

HHS

PHSA §§3201 through 3210

Oct. 6, 2011

Consumer Operated and Oriented Plan Program: Frequently Asked Questions [cciio.cms.gov]

HHS

ACA §1322

Sept. 13, 2011

Health Coverage-Related Payments: safe harbor contemplated for employers to determine the affordability of their health coverage and to avoid the assessable payment under Code §4980H(b); request for comments; Notice 2011-73, 2011-40 I.R.B. 474; IRS News Release IR-2011-92

IRS, Treasury

Code §4980H

Sept. 9, 2011

Health Insurance Exchanges: request for information regarding state flexibility to establish a basic health program; 76 Fed. Reg. 56767 (9/14/11)

HHS

ACA §1331

Sept. 1, 2011

Premium Review Process; Association Plans: amendments to rate review final rules to include association coverage in rate review process regardless of state definitions, effective on or after November 1, 2011; 45 CFR Part 154, 76 Fed. Reg. 54969 (9/6/11)

HHS

PHSA §2794

Sept. 1, 2011

Association Plans: application of individual and group market requirements under PHSA Title XXVII when insurance coverage is sold to, or through, associations (including trusts, multiple employer welfare arrangements (MEWAs), and purchasing cooperatives); generally, size of participating employer determines whether employer's coverage is subject to small or large group market; CMS Guidance [cciio.cms.gov]

HHS

PHSA §2791

August 19, 2011

Annual and Lifetime Limits: health reimbursement arrangements (HRAs) that are subject to PHSA §2711 requirements and that were in effect before September 23, 2010, are exempted from applying for waivers or waiver extensions from restrictions on annual limits, CCIIO 2011-1E [cciio.cms.gov]

HHS

PHSA §2711

August 17, 2011

Summary of Benefits and Coverage: proposed rules for disclosure of the SBC and the uniform glossary for group health plans and health insurance coverage; comments are due by October 21, 2011; REG-140038-10 (Treas. Prop. Regs. §54.9815-2715), DOL Prop. Regs. §2590.715-2715, Prop. 45 CFR §147.200, 76 Fed. Reg. 52442 (8/22/11); proposed SBC template with instructions and sample language, 76 Fed. Reg. 52475 (8/22/11)

Treasury,
DOL,
HHS

Treasury,
DOL,
HHS

PHSA §2715

August 12, 2011

Health Care Premium Tax Credit: proposed regulations provide guidance for individuals who enroll in qualified health plans through insurance Exchanges and claim health insurance premium tax credit under §36B; REG-131491-10, 76 Fed. Reg. 50931 (8/17/11); request for comments; see also CMS proposed changes to Medicaid and CHIP eligibility to align with Exchange requirements and §36B credit, 76 Fed. Reg. 51148 (8/17/11)

IRS, Treasury

Code §36B

August 12, 2011

Health Insurance Exchanges: proposed rule implementing: Exchange functions in individual market— eligibility determinations for Exchange participation and insurance affordability programs (Prop. 45 CFR §§155.300 et seq.); and standards for employer participation in a Small Business Health Options Program (SHOP)) (Prop. 45 CFR Part 155); comments requested; 76 Fed. Reg. 51202 (8/17/11)

HHS

ACA §§1311, 1312, 1411-1413

August 3, 2011

Claims and Appeals: preliminary determination of whether the external appeals review process of each state or territory meets strict consumer protection standards, meets similar standards, or meets neither (requiring the use of an HHS-administered process or accredited independent review organizations) [cciio.cms.gov]

HHS

PHSA §2719

August 1, 2011

Preventive Health Services: rules amended to allow Health Resources and Services Administration to exempt group health plans of religious employers from contraceptives requirements for women's preventive services; T.D. 9541, 76 Fed. Reg. 46621 (8/3/11); REG-120391-10, 76 Fed. Reg. 46677 (8/3/11); HRSA guidelines for women's preventive services, effective August 1, 2011 [www.hrsa.gov]

Treasury,
DOL,
HHS

 

HRSA

PHSA §2713

July 22, 2011

Claims and Appeals: corrections to interim final rules, effective July 22, 2011; 76 Fed. Reg. 44491 (7/26/11)

Treasury,
DOL,
HHS

PHSA §2719

July 18, 2011

Medical Loss Ratios: questions and answers regarding interim final rule; CCIIO 2011-004, July 18, 2011 [cciio.cms.gov]

HHS

PHSA §2718

July 18, 2011

Consumer Operated and Oriented Plan Program: proposed rules for governance of the CO-OP program and the terms for loan awards (Prop. 45 CFR §§156.500 to 156.520); request for comments; 76 Fed.  Reg. 43237 (7/20/11)

HHS

ACA §1322

July 12, 2011

Automatic Enrollment: transcript of April 8, 2011, Public Forum on Automatic Enrollment in Large Employer Health Plans [www.dol.gov/ebsa]

DOL

Fair Labor Standards Act §18A

July 11, 2011

Health Insurance Exchanges: proposed requirements for states to establish and operate a health exchange and basic standards for employers to participate in a Small Business Health Options Program (SHOP)) (Prop. 45 CFR Part 155); proposed minimum requirements for health insurance issuers to participate in an exchange and offer qualified health plans (QHPs) (Prop. 45 CFR §§156.10 to 156.295); request for comments; 76 Fed. Reg. 41866 (7/15/11)

HHS

ACA §§1301-1304, 1311, 1312, 1321, 1334, 1411-1413

July 11, 2011

Health Insurance Exchanges: proposed state and health insurance issuer standards related to temporary reinsurance, temporary risk corridors, and permanent risk adjustment programs (Prop. 45 CFR Part 153); request for comments; 76 Fed. Reg. 41930 (7/15/11)

HHS

ACA §§1321, 1341-1343

June 22, 2011

Claims and Appeals: revisions to internal claims and appeals and external review processes interim final rules, including extension of transition period to implement state external review processes through 2011, effective July 22, 2011; T.D. 9532 (Treas. Regs. §54.9815-2719T), DOL Regs. §2590.715-2719, 45 CFR §147.136; 76 Fed. Reg. 37208 (6/24/11); REG-125592-10, 76 Fed. Reg. 37037 (6/24/11). As corrected by 76 Fed. Reg. 44491 (7/26/11)

Treasury,
DOL,
HHS

 

Corrected

PHSA §2719

June 22, 2011

Claims and Appeals: temporary consumer protections that may be applied until January 1, 2014, for state external review process to be considered NAIC-similar (i.e., authorized under PHSA §2719(b)(2) and Treas. Regs. §54.9815-2719T(d)), EBSA Technical Release 2011-02 (and CMS Technical Release 2011-02) [cciio.cms.gov]

DOL,
HHS

PHSA §2719

June 22, 2011

Claims and Appeals: updated instructions for calculating county level estimates pertaining to the culturally and linguistically appropriate standards in the internal claims and appeals and external review processes, CMS Technical Guidance [cciio.cms.gov]

HHS

PHSA §2719

June 22, 2011

Governmental Plans; Claims and Appeals: instructions for self-insured nonfederal governmental health plans and health insurance issuers on how to elect a federal external review process, CMS Technical Guidance [cciio.cms.gov]

HHS

PHSA §2719

June 17, 2011

Medical Loss Ratios: revised instructions for 2011 MLR quarterly reporting forms for mini-med and expatriate plans [cciio.cms.gov]

HHS

PHSA §2718

June 10, 2011

Medical Loss Ratios: temporary relief for Blue Cross or Blue Shield organizations and others in qualifying for §833 tax treatment extended to any taxable year beginning in 2010 and first taxable year beginning after December 31, 2010, Notice 2011-51, 2011-27 I.R.B. 36

IRS

Code §833; PHSA §2718

June 9, 2011

Fees on Self-Insured Health Plan Sponsors and Health Insurance Policy Issuers: Request for comments on how fees to fund Patient-Centered Outcomes Research Trust Fund should be determined and paid, including safe harbors and transition rules; Notice 2011-35, 2011-25 I.R.B. 879

IRS, Treasury

Code §§4375, 4376

May 31, 2011

High Risk Pool Program: HHS fact sheet announces steps to reduce premiums under Pre-Existing Condition Insurance Plan beginning July 1 and simplify enrollment in federally-administrated PCIP programs [www.pciplan.com]

HHS

ACA §1101

May 19, 2011

Medical Loss Ratios: MLR quarterly reporting forms and instructions for mini-med and expatriate plans; CCIIO 2011-003, June 30, 2011, deadline for first report [cciio.cms.gov]

HHS

PHSA §2718

May 19, 2011

Premium Review Process: final rules for health insurance issuers regarding the disclosure and review of unreasonable rate increases; 45 CFR Part 154, 76 Fed. Reg. 29964 (5/23/11)

HHS

PHSA §2794

May 13, 2011

Medical Loss Ratios: CCIIO 2011-002, Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule [cciio.cms.gov]

HHS

PHSA §2718

May 3, 2011

Health Coverage-Related Payments; Waiting Period Limitation: Request for comments on shared employer responsibility provisions (e.g., how to determine who is a full-time employee), PHSA 90-day waiting period limitation, and coordination of provisions; Notice 2011-36, 2011-21 I.R.B. 792; IRS News Release IR-2011-50

IRS, Treasury

Code §4980H; PHSA §2708

April 26, 2011

Medical Loss Ratios: CCIIO 2011-001, timeframe for issuers of mini-med and expatriate plans to submit first 2011 quarterly reports of MLR data extended and due date to be announced when quarterly reporting form is finalized; mid-June due date anticipated [cciio.cms.gov]

HHS

PHSA §2718

April 15, 2011

Free Choice Vouchers; Consumer Operated and Oriented Plan Program: 2011 Continuing Appropriations Act, P.L. 112-10, repeals free choice voucher provisions, effective as if included in PPACA, and cancels $2.2 billion of $6 billion in funds for CO-OP Program

P.L. 112-10,

ACA §10108, former Code §139D, and Code §§36B, 162, 4980H, 6056; ACA §1322

April 14, 2011

Health Care Premium Tax Credit: Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, P.L. 112-9, amends tax on advance payments in excess of refundable credit allowed for coverage under a qualified health plan

 

Code §36B

April 1, 2011

Grandfathered Health Plan Status: FAQs (Part VI) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

ACA §1251

April 1, 2011

Long-Term Care: Community Living Assistance Services and Supports (CLASS) FAQs [www.aoa.gov]

HHS

PHSA §§3201 through 3210

April 1, 2011

Governmental Plans: HIPAA exemption election instructions for self-funded, nonfederal governmental plans;

[cciio.cms.gov]

HHS

PHSA §2722

March 29, 2011

Form W-2 Reporting: Interim guidance on reporting the aggregate cost of employer-sponsored health coverage beginning with 2012 Forms W-2 and for voluntarily filed 2011 Forms W-2; transitional relief for certain employers and certain types of coverage; Notice 2011-28, 2011-16 I.R.B. 656; IRS News Release IR-2011-31; FAQs [www.irs.gov]

IRS

 

IRS

Code §6051(a)(14)

March 18, 2011

Claims and Appeals: enforcement grace period modified and extended generally until plan years beginning on or after January 1, 2012, for compliance with some standards set forth in interim regulations for internal claims and appeals, EBSA Technical Release 2011-01; list of states with consumer assistance programs [www.dol.gov/ebsa]

DOL
(HHS,
Treasury)

PHSA §§2719, 2793

March 10, 2011

Waivers for State Innovation: proposed procedures for states to receive a waiver and to create their own plans to implement health care reform; request for comments; 76 Fed. Reg. 13553 (3/14/11)

Treasury, HHS

ACA §1332

March 10, 2011

Consumer Operated and Oriented Plan Program: conditions for tax exemption of nonprofit health insurance issuers; IRS not accepting applications for recognition of exempt status until publication of revenue procedure on how to apply; reporting and filing; request for comments; Notice 2011-23, 2011-13 I.R.B. 588

IRS

Code §501(c)(29)

February 11, 2011

Student Health Insurance Coverage: proposed rule for this individual health insurance coverage sets out applicability of guaranteed availability and renewability, annual limits, preventive services, choice of health care provider, and medical loss ratio requirements for policy years beginning on or after January 1, 2012; 76 Fed. Reg. 7767 (2/11/11)

HHS

ACA §1560(c); PHSA §§2711, 2713, 2718, 2719A, 2741, 2742

February 2, 2011

Consumer Operated and Oriented Plan Program: request for comments on establishment of CO-OP Program and loan and grant criteria for qualified nonprofit health insurance issuers; 76 Fed. Reg. 5774 (2/2/11)

HHS

ACA §1322

February 1, 2011

Center for Consumer Information and Insurance Oversight (CCIIO) replaces Office of Consumer Information and Insurance Oversight (OCIIO)

HHS

 

2010

Date

Guidance Issued

Agency

Authority

Dec. 29, 2010

Medical Loss Ratios: nonsubstantive corrections to interim final rules; 75 Fed. Reg. 82277 (12/30/10)

HHS

PHSA §2718

Dec. 28, 2010

Preventive Health Services: request for information on how group health plans and health insurance issuers can employ value-based insurance design in covering recommended preventive services, due February 28, 2011; 75 Fed. Reg. 81544 (12/28/10)

Treasury,
DOL,
HHS

PHSA §2713

Dec. 27, 2011

Medical Loss Ratios: procedures for Blue Cross and Blue Shield organizations to obtain automatic consent to change method of accounting for unearned premiums, effective December 27, 2010; Notice 2011-4, 2011-2 I.R.B. 282

IRS

Code §833; PHSA §2718

Dec. 23, 2010

Drug and Medicine Expense Reimbursements from Employer Health Plans: guidance on use of health FSA and HRA debit cards for purchases made after January 15, 2011, for over-the-counter medicines or drugs that are prescribed; Notice 2011-5, 2011-3 I.R.B. 314, modifying Notice 2010-59 Questions and Answers on Over-the-Counter Medicines and Drugs; IRS News Release IR-2010-128

IRS

 

 

Code §§105, 106(f), 220(d)(2), 223(d)(2)

Dec. 22, 2010

Discrimination — Highly Compensated Individuals: Insured group health plans not required to comply with nondiscrimination rules until period after administrative guidance is issued; Notice 2011-1, 2011-2 I.R.B. 259

IRS
(DOL,
HHS)

PHSA §2716

Dec. 22, 2010

Deduction Limitation for Remuneration for Services to Health Insurance Providers: guidance on application of deduction limit to deferred deduction remuneration for taxable years 2010-2012, de minimis rule for premiums totaling less than 2% of gross revenue, exception for certain independent contractors, and treatment of indemnity reinsurance contract premiums, effective for taxable years beginning on or after January 1, 2010; Notice 2011-2, 2011-2 I.R.B. 260

IRS

Code §162(m)(6)

Dec. 22, 2010

Grandfathered Health Plan Status; Automatic Enrollment; Nondiscrimination Based on a Health Factor and Wellness Programs; Preventive Health Services; Dependent Coverage for Adult Children; Notice for Material Modifications to Health Plans; Mental Health and Substance Use Disorder Parity: FAQs (Part V) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

ACA §1251; Fair Labor Standards Act §18A; PHSA §§2705, 2713, 2714, 2715; Code §9812 and ERISA §712

Dec. 21, 2010

Premium Review Process: proposed regulations to implement rules for health insurance issuers regarding the disclosure and review of unreasonable rate increases; 45 CFR Part 154, 75 Fed. Reg. 81004 (12/23/10)

HHS

PHSA §2794

Dec. 15, 2010

Health Care Premium Tax Credit: Medicare and Medicaid Extenders Act, P.L. 111-309, amends tax on advance payments in excess of refundable credit allowed for coverage under a qualified health plan

P.L. 111-309

Code §36B

Dec. 9, 2010

Annual and Lifetime Limits: OCIIO 2010-1C limits situations in which insurers with annual limit waiver can continue to sell new mini-med plans after September 23, 2010 [www.healthcare.gov]

HHS

PHSA §2711

Dec. 9, 2010

Annual and Lifetime Limits: OCIIO 2010-1B, model language needed for transparency requirements of OCIIO 2010-1A for mini-med policies [www.healthcare.gov]

HHS

HHS

PHSA §2711

Dec. 2, 2010

Small Employer Health Care Tax Credit: guidance on tax credit for small businesses and tax-exempt organizations; Notice 2010-82, 2010-51 I.R.B. 857; Form 8941, Credit for Small Employer Health Insurance Premiums, and Instructions released; IRS News Release IR-2010-117

IRS

 

IRS

Code §45R

Nov. 22, 2010

Medical Loss Ratios: temporary relief for Blue Cross or Blue Shield organizations and others in qualifying for §833 tax treatment for the first taxable year beginning after December 31, 2009, Notice 2010-79, 2010-49 I.R.B. 809

IRS

Code §833; PHSA §2718

Nov. 22, 2010

Medical Loss Ratios: interim final rules on disclosures and reporting, calculating and providing premium rebates, and enforcement and penalties, incorporating NAIC recommendations on MLR definitions and methodologies, effective January 1, 2011, with request for comments; 45 CFR Part 158, 75 Fed. Reg. 74864 (12/1/10)

HHS

 

NAIC

PHSA §2718

Nov. 15, 2010

Grandfathered Health Plan Status: interim final rules modified (T.D. 9489) to allow changes to carrier or insurance contracts and policies, effective November 15, 2010; T.D. 9506, 75 Fed. Reg. 70114 (11/17/10); REG-118412-10, 75 Fed. Reg. 70159 (11/17/10)

Treasury,
DOL,
HHS

ACA §1251

Nov. 12, 2010

Claims and Appeals: request for comments regarding development of federal external review process due December 8, 2010; 75 Fed. Reg. 70160 (11/17/10)

DOL
HHS

PHSA §2719

Nov. 5, 2010

Annual and Lifetime Limits; Medical Loss Ratios: OCIIO 2010-1A, annual limit waiver program — notice; assessing applications; applications from states with state-mandated policies; MLR rules and mini-med policies; audits [cciio.cms.gov]

HHS

PHSA §§2711, 2718

Oct. 28, 2010

Grandfathered Health Plan Status; Annual and Lifetime Limits:FAQs (Part IV) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

ACA §1251; PHSA §2711

Oct. 13, 2010

Preexisting Condition Exclusions: Questions and Answers on Enrollment of Children Under 19 updated [cciio.cms.gov]

HHS

PHSA §2704

Oct. 12, 2010

HIPAA Statutory Exemptions:FAQs (Part III) regarding impact on PPACA group market reforms [www.dol.gov/ebsa]

DOL
HHS
Treasury

PHSA §2722; ERISA §732; Code §9831

Oct. 12, 2010

Form W-2 Reporting: Requirement to report the aggregate cost of employer-sponsored health coverage (not including Archer MSAs, HSAs, or health FSAs) on Form W-2 waived for 2011; Notice 2010-69, 2010-44 I.R.B. 576

IRS

Code §6051(a)(14)

Oct. 8, 2010

Grandfathered Health Plan Status; Dental and Vision Benefits; Rescissions; Preventive Health Services; Individual Health Insurance Policy Year and Effective Date of PPACA — Dependent Coverage for Adult Children: FAQs (Part II) regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS
Treasury

ACA §1251; PHSA §§2722, 2712, 2713, 2714

Oct. 6, 2010

High Risk Pool Program: guidance on newborn coverage [cciio.cms.gov]

HHS

ACA §1101

Oct. 4, 2010

Automatic Enrollment regulations likely issued “in the next year or two” and will be prospective: remarks of Assistant Secy. of Labor Phyllis C. Borzi at International Foundation of Employee Benefit Plans' 29th Annual Employee Benefits Symposium

DOL

Fair Labor Standards Act §18A

Sept. 24, 2010

Preexisting Condition Exclusions: Questions and Answers on Enrollment of Children Under 19 updated [cciio.cms.gov]

HHS

PHSA §2704

Sept. 23, 2010

Governmental Plans; Claims and Appeals: interim enforcement safe harbor for federal external review for non-grandfathered, self-insured, nonfederal governmental health plans not subject to a state or territory external review process [cciio.cms.gov]

HHS

PHSA §2719

Sept. 21, 2010

Governmental Plans: HHS guidance to self-funded, nonfederal governmental plans regarding amendments to the HIPAA opt-out provision [cciio.cms.gov]

HHS

PHSA §2722

Sept. 20, 2010

Grandfathered Health Plan Status; Claims and Appeals; Dependent Coverage for Adult Children; Patient Protections; Discrimination — Highly Compensated Individuals: Frequently Asked Questions regarding Affordable Care Act Implementation [www.dol.gov/ebsa]

DOL
HHS

ACA §1251; PHSA §§2719, 2714, 2719A, 2716

Sept. 20, 2010

Claims and Appeals: enforcement grace period until July 1, 2011, for compliance with some standards set forth in interim regulations for internal claims and appeals, EBSA Technical Release 2010-02; model notice of adverse benefit determination revised [www.dol.gov/ebsa]

DOL
(HHS,
Treasury)

PHSA §2719

Sept. 20, 2010

Discrimination — Highly Compensated Individuals: Notice 2010-63, 2010-41 I.R.B. 420, discusses application of nondiscrimination rules in Code §105(h)(2) to insured group health plans and solicits comments

IRS
(DOL,
HHS)

PHSA §2716

Sept. 7, 2010

Small Employer Health Care Tax Credit: Draft Form 8941, Credit for Small Employer Health Insurance Premiums, released for small businesses and tax-exempt organizations to use to calculate credit; IRS News Release IR-2010-96

IRS

Code §45R

Sept. 3, 2010

Drug and Medicine Expense Reimbursements from Employer Health Plans: Notice 2010-59, 2010-39 I.R.B. 396, standards for reimbursement of expenses for over-the-counter drugs from FSAs, HRAs, HSAs and Archer MSAs, effective January 1, 2011; Questions and Answers on Over-the-Counter Medicines and Drugs; Rev. Rul. 2010-23, 2010-39 I.R.B. 388 (obsoleting Rev. Rul. 2003-102); IRS News Release IR-2010-95

IRS

 

IRS

Code §§105, 106(f), 220(d)(2), 223(d)(2)

Sept. 3, 2010

Annual and Lifetime Limits: OCIIO 2010-1, Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711, applicable to restricted annual limits

HHS

PHSA §2711

Sept. 1, 2010

Claims and Appeals: HHS interim procedures for federal external review for health insurance issuers in the group and individual markets in states that have not passed an external review law

HHS

PHSA §2719

August 23, 2010

Claims and Appeals: model disclosure notices; federal external review process for non-grandfathered self-insured group health plans not subject to a state process, effective for plan years beginning on or after September 23, 2010 — interim enforcement safe harbor, EBSA Technical Release 2010-01; notice, 75 Fed. Reg. 52597 (8/26/10)

Treasury,
DOL,
HHS

PHSA §2719

July 30, 2010

Health Insurance Exchanges: request for comments regarding planning and establishment due October 4, 2010; 75 Fed. Reg. 45584 (8/3/10)

HHS

ACA §§1311, 1321

July 30, 2010

High Risk Pool Program: Pre-Existing Condition Insurance Plan interim final rules with request for comments, effective July 30, 2010; 45 CFR Part 152, 75 Fed. Reg. 45014 (7/30/10)

HHS

ACA §1101

July 27, 2010

Preexisting Condition Exclusions: HHS posts Questions and Answers on Enrollment of Children Under 19

HHS

PHSA §2704

July 22, 2010

Claims and Appeals: internal claims and appeals and external review processes interim final rules with request for comments, generally effective for plan years beginning on or after September 23, 2010; T.D. 9494 (Treas. Regs. §54.9815-2719T), DOL Regs. §2590.715-2719, 45 CFR §147.136; 75 Fed. Reg. 43330 (7/23/10); REG-125592-10, 75 Fed. Reg. 43109 (7/23/10)

Treasury,
DOL,
HHS

PHSA §2719

July 22, 2010

Consumer Assistance Program: grant program applications available to states and territories for health insurance consumer assistance offices and ombusdman programs [http://www.healthcare.gov]

HHS

PHSA §2793

July 14, 2010

Preventive Health Services: interim final rules with request for comments, effective for plan years beginning on or after September 23, 2010; T.D. 9493 (Treas. Regs. §54.9815-2713T), DOL Regs. §2590.715-2713, 45 CFR §147.130; 75 Fed. Reg. 41726 (7/19/10); REG-120391-10, 75 Fed. Reg. 41787 (7/19/10)

Treasury,
DOL,
HHS

PHSA §2713

July 1, 2010

High Risk Pool Program: Pre-Existing Condition Insurance Plan application for enrollment begins for states in which HHS runs temporary program [www.pcip.gov]

HHS

ACA §1101

July 1, 2010

Health Care Reform Insurance Web Portal: HHS's HealthCare.gov website launched

HHS

ACA §1103(a)

June 29, 2010

Dependent Coverage for Adult Children: FAQs updated

Treasury,
DOL,
HHS

PHSA §2714

June 22, 2010

Annual and Lifetime Limits; Patient Protections; Preexisting Condition Exclusions; Rescissions of Coverage: interim final rules on “Patient's Bill of Rights” with request for comments, generally effective for plan years beginning on or after September 23, 2010; T.D. 9491 (Treas. Regs. §§54.9815-2704T, 54.9815-2711T, 54.9815-2712T, 54.9815-2719AT), DOL Regs. §§2590.715-2704, -2711, -2712, -2719A, 45 CFR §§147.108, .126, .128, .138; 75 Fed. Reg. 37188 (6/28/10); REG-120399-10, 75 Fed. Reg. 37242 (6/28/10)

Treasury,
DOL,
HHS

PHSA §§2704, 2711, 2712, 2719A

June 14, 2010

Grandfathered Health Plan Status: interim final rules with request for comments, generally effective for plan years beginning on or after September 23, 2010; T.D. 9489 (Treas. Regs. §54.9815-1251T), DOL Regs. §2590.715-1251, 45 CFR §147.140; 75 Fed. Reg. 34538 (6/17/10); REG-118412-10, 75 Fed. Reg. 34571 (6/17/10); FAQs

Treasury,
DOL,
HHS

HHS

ACA §1251

June 10, 2010

High Risk Pool Program: solicitation for state proposals to operate pools for uninsured individuals with preexisting conditions, including design requirements for temporary program

HHS

ACA §1101

May 27, 2010

Minimum Essential Coverage: P.L. 111-173, amending definition regarding health care provided by Secretary of Veterans Affairs

 P.L. 111-173

Code §5000A

May 17, 2010

Small Employer Health Care Tax Credit: Notice 2010-44, 2010-22 I.R.B. 717, guidelines for determining whether employer qualifies for the credit and for estimating the credit amount; IRS News Release IR-2010-63

IRS

Code §45R

May 10, 2010

Dependent Coverage for Adult Children: interim final rules with request for comments, effective for plan years beginning on or after September 23, 2010; T.D. 9482 (Treas. Regs. §54.9815-2714T), DOL Regs. §2590.715-2714, 45 CFR §147.120, 75 Fed. Reg. 27122 (5/13/10); REG-114494-10, 75 Fed. Reg. 27141 (5/13/10); HHS FAQs (updated June 29, 2010)

Treasury,
DOL,
HHS

HHS

PHSA §2714

May 3, 2010

Small Employer Health Care Tax Credit: Rev. Rul. 2010-13, 2010-21 I.R.B. 691, HHS-determined average premium for small group market in each state for 2010 taxable year

IRS

Code §45R

May 3, 2010

Health Care Reform Insurance Web Portal: interim final rules with comment period, effective May 10, 2010; 45 CFR §§159.100 et seq., 75 Fed. Reg. 24470 (5/5/10)

HHS

ACA §1103(a)

April 27, 2010

Dependent Coverage for Adult Children: Notice 2010-38, 2010-20 I.R.B. 682, tax treatment of employer-provided health care coverage for children under age 27; IRS News Release IR-2010-53

IRS

Code §§105(b), 106, 125, 401(h), 501(c)(9)

April 26, 2010

Minimum Essential Coverage: TRICARE Affirmation Act, P.L. 111-159, amending definition

 P.L. 111-159

Code §5000A

April 23, 2010

High Risk Pool Program: Fact sheet with estimated state allocations of funds for temporary program [http://cciio.cms.gov]

HHS

ACA §1101

April 14, 2010

HHS Office of Consumer Information and Insurance Oversight (OCIIO) created; 75 Fed. Reg. 20364 (4/19/10)

HHS

 

April 12, 2010

Medical Loss Ratios: request for comments due May 14, 2010; 75 Fed. Reg. 19297 (4/14/10)

Treasury,
DOL,
HHS

PHSA §2718

April 12, 2010

Premium Review Process: request for comments due May 14, 2010; 75 Fed. Reg. 19335 (4/14/10)

Treasury,
DOL,
HHS

PHSA §2794

April 1, 2010

Small Employer Health Care Tax Credit: “Small Business Health Care Tax Credit: Frequently Asked Questions”; IRS News Release IR-2010-38

IRS

Code §45R

March 30, 2010

Health Care and Education Reconciliation Act of 2010, P.L. 111-152 (HCERA)

 P.L. 111-152

 

March 24, 2010

Executive Order 13535: ensuring enforcement and implementation of abortion restrictions in PPACA; 75 Fed. Reg. 15599 (3/29/10)

 Order

ACA §1303

March 23, 2010

Patient Protection and Affordable Care Act, P.L. 111-148 (PPACA)

 P.L. 111-148