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Healthcare Update: HHS Releases Market Reform and Essential Benefits Rules; Federal Government to Operate Exchanges in 26 States; CMS Issues Proposed MLR Rule for Medicare Advantage and Part D; Supreme Court Blocks Georgia Hospital Merger

February 26, 2013 8:29 AM | Print this page |
Leslie Levinson
HHS RELEASES "MARKET REFORM" RULE AND REPORT
On February 22, the Department of Health and Human Services (HHS) released a final rule to implement several key provisions of the Patient Protection and Affordable Care Act (PPACA), including a prohibition against denying health insurance or charging "discriminatory" premiums to enrollees who have pre-existing medical conditions. An accompanying press release from HHS proclaimed, "Health care law protects consumers against worst insurance practices - Key health insurance protections for all Americans moves forward." The "Health Insurance Market Rules; Rate Review" rule will be published in the Federal Register on February 27.

In addition to the "guaranteed availability" provision for new insurance applications, the final rule provides for guaranteed renewability, prohibiting a health insurer from refusing to renew an insured’s coverage after an illness. Insurers also may not charge insureds different premiums except based on age, tobacco use, family size and geography, and cannot create separate risk pools to charge higher premiums to higher-cost insureds. Finally, “catastrophic plans” will be available to people for whom coverage would otherwise be unaffordable. HHS issued a fact sheet containing a summary of the rule’s protections.

Also on February 22, HHS released a report entitled "Health Insurance Premium Increases in the Individual Market Since the Passage of the Affordable Care Act," which concluded that the rate of increases in premiums in the individual health insurance market has slowed since PPACA was enacted in 2010.

Click here for a complete copy of the Update.