Fact Sheets

Comments for the Federal Register about Regulations in the Affordable Care Act

Health

ACA-Comments2013This page features comments from First Focus submitted to the Federal Register regarding regulations of the Affordable Care Act.

A printer and email-friendly PDF is also available for download.


 

Data Collection and Application for Individuals for Medicaid, CHIP, Exchange, and Employers and Employees in the Small Business Health Option Program (CMS-10440)
Issued January 25, 2013

Centers for Medicare and Medicaid Services (CMS)

Summary: The Affordable Care Act directs the Secretary of Health and Human Services to develop and provide to each State a single, streamlined form that may be used to apply for coverage through the Exchange and Insurance Affordability Programs, including APTC/CSR, Medicaid, CHIP, and the Basic Health Program, if applicable.

Read the First Focus comments here.
Read the group comments here.
Read the group (National Health Care for the Homeless Council) comments here.


 

Medicaid, Children’s Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing
Issued January 22, 2013

Read the regulation details here.

Centers for Medicare Medicaid Services (CMS)
42 CFR Parts 430, 431, 435, and 457
RIN: 0938-AR04

Summary: This proposed rule would implement provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act), and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This proposed rule reflects new statutory eligibility provisions; proposes changes to provide states more flexibility to coordinate Medicaid and the Children’s Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act; modernizes and streamlines existing rules, eliminates obsolete rules, and updates provisions to reflect Medicaid eligibility pathways; revises the rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; implements other CHIPRA eligibility-related provisions, including eligibility for newborns whose mothers were eligible for and receiving Medicaid or CHIP coverage at the time of birth; amends certain provisions included in the “State Flexibility for Medicaid Benefit Packages” final rule published on April 30, 2010; and implements specific provisions including eligibility appeals, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also proposes to update and simplify the complex Medicaid premiums and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities.

Read the First Focus comments here.
Read the First Focus comments here.
Read the group comments here.


 

Patient Protection and Affordable Care Act: Establishment of Multi-State Plan Program
Issued December 5, 2012

Read the regulation details here.

U.S. Office of Personnel Management
45 CFR Part 800
RIN 3206-AM47

Summary: The U.S. Office of Personnel Management (OPM) seeks comments on a proposed rule to implement the MultiState Plan Program (MSPP). OPM is establishing the MSPP pursuant to the Patient Protection and Affordable Care Act. Through contracts with OPM, health insurance issuers will offer at least two multi-State plans (MSPs) on each of the Affordable Insurance Exchanges (Exchanges). Under the law, an MSPP issuer may phase in the States in which it offers coverage over four years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP.


 

Incentives for Nondiscriminatory Wellness Programs in Group Health Plans
Issued November 26, 2012

Read the regulation details here.

U.S. Department of Labor
U.S. Department of Health and Human Services

77 FR 70619

Summary: HHS and the Department of Labor seek comments on proposed rules regarding nondiscriminatory wellness programs in group health coverage. Specifically, these proposed regulations would increase 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 proposed regulations would further increase the maximum permissible reward to 50 percent for wellness programs designed to prevent or reduce tobacco use. These regulations also include other proposed clarifications regarding the reasonable design of health contingent wellness programs and the reasonable alternatives they must offer in order to avoid prohibited discrimination.

Read the group comments here.


 

Rule: Patient Protection and Affordable Care Act; Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation
Issued November 26, 2012

Read the regulation details here.

Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
45 CFR Parts 147, 155, and 156
[CMS-9880-P]

Summary: This proposed rule details standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this proposed rule outlines Exchange and issues standards related to coverage of essential health benefits and actuarial value. This proposed rule also
proposes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges.

Read the group comments here.


 

Pre-Existing Condition Insurance Plan Program
Issued August 30, 2012

Read the regulation details here.

Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
45 CFR Parts 147, 155, and 156
[CMS-9880-P]

Summary: HHS is asking for comments on an amendment regarding program eligibility to the interim final regulation implementing the Pre-Existing Condition Plan (PCIP) program under provisions of the ACA. The amendment prevents teenagers and young adults who are granted deferred action through Deferred Action for Childhood Arrivals (DACA) program from being eligible for the ACA’s federally funded PCIP, buying health insurance in the Exchange, or from accessing the premium tax credits.

Read the First Focus comments here.


 

Solicitation of Public Input on Conversion of Net Income Standards to Equivalent Modified Adjusted Gross Income Standards
Issued June 21, 2012

Read the regulation/rule details here.

Summary: CMS is seeking comments on two potential methodologies for converting current State Medicaid and CHIP net income eligibility standards to equivalent modified adjusted gross income (MAGI) standards. Under the ACA, Medicaid and CHIP eligibility will be based on MAGI standards starting January 1, 2014. Currently, state Medicaid and CHIP programs use a net income standard and current income disregards approach. CMS invites input on alternative approaches of achieving income conversion.

Read the group comments here.


 

Request for Domains, Instruments, and Measures for Development of a Standardized Instrument for Use in Public Reporting of Enrollee Satisfaction with their Qualified Health Plan and Exchange – Notice
Issued June 21, 2012

Read the regulation/rule details here.

[CMS-9963-NC]

Summary: Request for information to assist HHS in measuring consumer experiences related to purchasing health plans in the Exchanges.

Read the group comments here.


 

ACA; Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans – Proposed Rule
Issued June 5, 2012

Read the regulation/rule details here.

U.S. Department of Health and Human Services
45 CFR Part 156
[CMS-9965-P]
RIN 0938-AR36

Summary: Request for public comment regarding the establishment of data collection standards, including a requirement for the three largest small employer health insurance issuers to report data on benefit designs, scope of services, and limits on benefits within the ten Essential Health Benefits (EHB) categories established by the ACA.

Read the group comments here.


 

General Guidance on Federally-Facilitated Exchanges
Issued May 16, 2012

Read the regulation/rule details here.

Centers for Medicare & Medicaid Services
Center for Consumer Information and Insurance Oversight

Summary: Guidance on the federally-run insurance Exchange that will be set up for states that do not move ahead on a state-based or federal-state hybrid Exchange. States will have to indicate to HHS by November 16, 2012 whether they plan to run their own Exchange, partner with the federal government on a federal-state Exchange, or have the federal government set up an Exchange for them.

Read the group comments here.


 

Medicaid Program; Payments for Services Furnished by Certain Primary Care Physicians and Charges for Vaccine Administration Under the Vaccines for Children Program – Proposed rule
Issued May 11, 2012

Read the regulation/rule details here.

Department Of Health AndHuman Services
Centers for Medicare & Medicaid Services
42 CFR Parts 438, 441, and 447
[CMS–2370–P]
RIN 0938–AQ63

Summary: Request for public comment regarding increased Medicaid reimbursement for primary care services in 2013 and 2014 at Medicare rates. The proposed rule specifies which services and types of physicians qualify for the increased payment rates and the method for calculating the payment amount.

Read the group comments here.


 

Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final rule, Interim final rule
Issued March 27, 2012

Read the regulation/rule details here.

45 CFR Parts 155, 156, and 157
[CMS–9989–F]
RIN 0938–AQ67

Summary: Final rule implementing the new health insurance Exchanges.

Read the First Focus comments here.
Read the group comments here.


 

Medicaid Program; Eligibility Changes Under the Affordable Care Act – Final rule; Interim final rule
Issued March 23, 2012

Read the regulation/rule details here.

Centers for Medicare & Medicaid Services
42 CFR Parts 431, 435, and 457
[CMS–2349–F]
RIN 0938–AQ62

Summary: Final rule implementing policy and procedural changes to Medicaid and CHIP related to eligibility, enrollment, renewals, public availability of program information, and coordination across insurance affordability programs.

Read the First Focus comments here.
Read the group comments here.


 

Essential Health Benefits Bulletin
Issued December 16, 2011

Read the regulation/rule details here.

Center for Consumer Information and
Insurance Oversight

Summary: Request for public comment on a pre-regulatory Bulletin meant to give states more flexibility in implementing the insurance reforms of the ACA by allowing them to decide what essential health benefits will be required of plans in their state.

Read the First Focus comments here.
Read the group comments here.


Health Insurance Premium Tax Credit – Notice of proposed rulemaking and notice of public hearing

Issued August 17, 2011

Read the regulation/rule details here.

Internal Revenue Service (IRS), Treasury
26 CFR Part 1
[REG–131491–10]
RIN 1545–BJ82

Summary: Request for public comment regarding the health insurance premium tax credit, providing guidance to individuals who enroll in qualified exchange health plans, and to exchanges that make qualified health plans available to individuals and employers.

Read the First Focus comments here.
Read the group comments here.
Read the sign-on letter here.


 

Patient Protection and Affordable Care Act; Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers – Proposed rule.
Issued August 17, 2011

Read the regulation/rule details here.

45 CFR Parts 155 and 157
[CMS–9974–P]
RIN 0938–AR25

Summary: Request for public comment regarding exchange functions in the individual market, including eligibility determinations for exchange participation and insurance affordability programs and standards for employers.

Read the First Focus comments here.
Read the group comments here.


 

Medicaid Program; Eligibility Changes Under the Affordable Care Act – Proposed rule
Issued August 17, 2011

Read the regulation/rule details here.

42 CFR Parts 431, 433, 435, and 457
[CMS–2349–P]
RIN 0938–AQ62

Summary: Request for public comment regarding the establishment of the new health insurance exchanges; coordination between Medicaid, CHIP, and the new health insurance exchanges; and Medicaid and CHIP eligibility, enrollment simplification, and coordination.

Read the First Focus comments here.


 

Planning and Establishment of State-Level Exchanges; Request for Comments Regarding Exchange-Related Provisions in Title I of PPACA
Issued August 3, 2010

Read the regulation/rule details here.

OCIIO-9989-NC
45 CFR Part 170

Summary: Request for public comment regarding the Exchange-related provisions of the Affordable Care Act in advance of future rulemaking and grant solicitations.

Read the First Focus comments here.


 

Pre-Existing Condition Insurance Plan Program
Issued July 30, 2010

Read the regulation/rule details here.

OCIIO–9995–IFC
45 CFR Part 152
RIN 0991–AB71

Summary: Interim final rules with request for comments regarding the temporary high-risk pool program covering individuals with pre-existing conditions.

Read the First Focus comments here.


 

Maternal, Infant, and Early Childhood Home Visiting Program
Issued July 23, 2010

Read the regulation/rule details here.

FR Doc. 2010–18013
BILLING CODE 4165–15–P

Summary: Request for public comment on proposed criteria for evidence of effectiveness of home visiting program models for pregnant women, expectant fathers, and caregivers of children birth through kindergarten entry.

Read the First Focus comments here.


 

Internal Claims and Appeals and External Review Processes under the Patient Protection and Affordable Care Act
Issued July 23, 2010

Read the regulation/rule details here.

TD 9494
OCIIO-9993-IFC
RIN 1545-BJ63
RIN 1210-AB45
RIN 0991-AB70
26 CFR Parts 54 and 602
29 CFR Part 2590
45 CFR Part 147

Summary: Interim Final Rules for group health plans and health insurance issuers relating to internal claims and appeals and external review processes with request for comments.

Read the group comments here.


 

Coverage of Preventative Services under the Patient Protection and Affordable Care Act
Issued July 19, 2010

Read the regulation/rule details here.

TD-9493
OCIIO-9992-IFC
RIN 1545-BJ60
RIN 1210-AB44
RIN 0938-AQ07
26 CFR Part 54
29 CFR Part 2590
45 CFR Part 147

Summary: Interim final rules for group health plans and health insurance coverage requiring provision of preventative services coverage and clarifying prohibition of cost-sharing requirements with request for comments.

Read the First Focus comments here.


 

Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Patient Protections
Issued June 28, 2010

Read the regulation/rule details here.

TD-9491
OCIIO-9994-IFC
RIN 1545-BJ61
RIN 1210-AB43
RIN 0991-AB69
6 CFR Parts 54 and 602
29 CFR Part 2590
45 CFR Parts 144,146, and 147

Summary: Interim final rules for group health plans and health insurance coverage regarding preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections with request for comments.

Read the First Focus comments here.


 

Grandfathered Health Plan Status under the Patient Protection and Affordable Care Act
Issued June 17, 2010

Read the regulation/rule details here.

OCIIO-9991-IFC
RIN 0991-AB68
45 CFR Part 147

Summary: Request for public comment on grandfathered health plan status under the Affordable Care Act.

Read the group comments here.


 

Dependent Coverage
Issued May 13, 2010

Read the regulation/rule details here.

OCIIO– 4150–IFC
45 CFR Parts 144, 146, and 147

Summary: Request for public comment on the interim final rules for group health plans and health insurance issuers relating to dependent coverage of children to age 26.

Read the group comments here.

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