Legislative and Regulatory Updates
rules stipulated in the Affordable Care Act
(ACA) that require insurers to publicly disclose and provide a justification for
proposed health insurance rate increases of 10 percent or more went into effect
Centers for Medicare & Medicaid Services (CMS) on Sept. 6 issued a
rule that amends the rule issued in May on rate increase disclosure and
review. The final rule clarifies that, for rate review purposes only, the
definitions of "individual market" and "small group market" under state
rate-filing laws would govern even if they differed from the definitions under
the Public Health Service Act. The rule also clarifies that coverage sold to
individuals and small groups through associations is subject to rate review on
or after Nov. 1.
CMS on Sept. 14 issued a
request for comments on Section 1331 of the ACA, which gives states
the option to establish basic health programs that would provide at least the
essential health benefits to be established under the ACA. The comment deadline
is Oct. 31.
Obama on Sept. 28
asked the Supreme Court to rule on the
constitutionality of the individual mandate in the ACA. The president requested
that the justices review the Aug. 12 decision by the U.S. Court of Appeals for
the 11th Circuit. In a split
the three-judge panel based in Atlanta said that Congress and the president
overstepped their authority by requiring all Americans to obtain health
insurance. The Supreme Court term begins on Oct. 3. If the court decides to hear
the case, a decision could be delivered sometime next year.
another ACA-related decision, the U.S. Court of Appeals for the 4th
Circuit on Sept. 8
ruled that Liberty University and Virginia Attorney General Ken Cuccinelli
lacked standing to challenge the individual mandate under the ACA. After the ACA
was passed, Virginia passed a law barring the individual mandate and then filed
the suit based on the conflict between state and federal law. The strategy of
using state laws to challenge a federal law had no merit, the Richmond,
Va., panel argued in its decision to dismiss the case.
Center for Consumer Information and Insurance Oversight has issued a
white paper on risk-adjustment implementation. The paper focuses more on
risk-adjustment methodology than on the proposed rule for the three risk-sharing
mechanisms under the ACA.
CMS has extended to Oct. 31 the deadline for comments on two
One proposed rule relates to the establishment of exchanges and qualified health
plans under the ACA. The other proposed rule sets the standards for reinsurance,
risk corridors, and risk adjustment. Comments on both proposed rules, which were
published in the July 15 Federal Register, originally were due on Sept. 28.