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Supplement to
June 14, 2013
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Supplement to June 14, 2013


[Official Guidance]

Text of HHS Proposed Regs on ACA Program Integrity: Exchange, SHOP, Premium Stabilization Programs and Market Standards
"This proposed rule sets forth oversight and financial integrity standards with respect to Exchanges, QHP issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also proposes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers in Exchanges, issuer participation in an FFE, and States' operation of a SHOP. Finally, it proposes additional standards for agents and brokers, geographic rating areas, and guaranteed availability and renewability.... [M]ost of the proposed standards are based on existing standards currently in effect in the private market, were previously proposed through the Blueprint process, discussed in agency-issued sub-regulatory guidance, or were discussed in the preambles to the Exchange Establishment Rule, Premium Stabilization Rule, and the HHS Notice of Benefit and Payment Parameters for 2014." (U.S. Department of Health and Human Services)

[Official Guidance]

HHS Fact Sheet on the ACA Program Integrity Proposed Rule
"HHS proposes standards for the oversight of states that operate either risk adjustment or reinsurance programs. The rule would require that states keep an accurate accounting for the programs, submit to HHS and make public reports on operations, and take other steps to ensure the soundness and transparency of the programs.... This rulemaking proposes standards for the oversight of State Marketplaces through monitoring, reporting, and oversight of financial activities and Marketplace activities. These mechanisms would assure that consumers are properly given their choices of coverage available, that consumers correctly receive advance payments of the premium tax credit or cost-sharing reductions if they qualify, and that Marketplaces are meeting the standards of the Affordable Care Act in a transparent manner.... To protect consumers and the financial integrity of Federally-facilitated Marketplaces, HHS proposes standards that would establish a progressive approach for the oversight of health insurance issuers.... HHS is proposing additional state flexibility by permitting a state to operate a State-based Small Business Health Options Program (SHOP) while HHS would operate an individual market Federally-facilitated Marketplace in that state.... [The proposed regulation would] build on existing standards for agents and brokers by clarifying the pathways through which agents and brokers will help consumers and small businesses in Federally-facilitated Marketplaces." (Center for Consumer Information & Insurance Oversight, Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services)

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