Academy Activities
On May 17, the Health Practice Financial Reporting Committee submitted comments to the National Association of Insurance Commissioners (NAIC). The committee responded to proposed modifications to the maintenance agenda submission form that addresses an accounting standards update related to fees paid to the federal government by health insurers under the Affordable Care Act (ACA).
The Academy published a new issue brief on May 9. Written by Senior Health Fellow Cori Uccello, it provided an overview of the basic concepts underlying premium calculations and highlighted and examined several ACA-related provisions that could affect premiums. In conjunction with the release of that issue brief, the Academy hosted a Capitol Hill briefing on May 17, during which presenters Audrey Halvorson and Uccello discussed how insurance premiums could be affected by several provisions in the ACA.
Also related to the new issue brief, Uccello testified on May 20 before the House Energy and Commerce Subcommittee on Oversight and Investigations on the effect of the ACA on premiums. |
Legislative and Regulatory Updates
 On May 22, the Department of Health and Human Services (HHS) released an interim final rule related to the Pre-Existing Condition Insurance Plan (PCIP). This rule sets the payment rates for covered services furnished to individuals enrolled in the PCIP program, beginning with covered services furnished on June 15. It also prohibits facilities and providers that, with respect to dates of service beginning on June 15, accept payment for most covered services in the federally administered PCIP from charging the enrollee an amount greater than the enrollee's out-of-pocket cost for the covered service as calculated by the plan. The rule is effective on June 15.
The Centers for Medicare & Medicaid Services (CMS) released a final rule on May 23 that implements new medical loss ratio requirements established under the ACA for the Medicare Advantage Program and the Medicare Prescription Drug Benefit Program. The rule is effective on July 22.
On May 31, HHS released a final rule that amends existing regulations for implementing provisions related to special enrollment periods and employee choice for the Small Business Health Options Program under the ACA. The final rule is effective July 13.
The Medicare Board of Trustees issued the 2013 Medicare trustees’ report on the financial status of Medicare on May 31. The report states that the Medicare Hospital Insurance Trust Fund has enough funds to cover its obligations through 2026, two years later than projected in the 2012 report.
On June 3, the Internal Revenue Service, Employee Benefits Security Administration, and CMS released a final rule regarding nondiscriminatory wellness programs in group health coverage. The rule increases the maximum permissible reward under a health-contingent wellness program offered in connection with a group health plan (and any related health insurance coverage) from 20 percent to 30 percent of the cost of coverage. The rule also increases the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. The rule is effective Aug. 2.
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