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PPACA: OCIIO Describes Changes Affecting Government Plans

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Self-funded, nonfederal governmental health plans will be facing new enrollee protection requirements, Steve Larsen says.

Larsen is director of the oversight office at the Office of Consumer Information and Insurance Oversight (OCIIO), an arm of the U.S. Department of Health and Human Services (HHS) that was created by the Affordable Care Act, the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA).

Larsen notes in a new public employee health plan memo that the Affordable Care Act has changed the rules that govern self-insured health plans provided by cities, states and other governmental entities other than the federal government.

In the past, Larsen says, the self-funded, nonfederal public employers could opt out of:

  • Preexisting condition exclusion periods limits.
  • Special enrollment periods requirements.
  • Prohibitions against discriminating against individual participants and beneficiaries based on health status.
  • Standards relating to benefits for newborns and mothers.
  • Mental health and substance abuse parity requirements.
  • Post-mastectomy reconstructive surgery requirements.
  • Requirements for coverage of dependent students on a medically necessary leave of absence.

Once the Affordable Care Act changes take effect, the self-insured government plans will still be able to opt out of the newborn and maternal care standards, mental parity requirements and post-mastectomy reconstructive surgery requirements, and the requirement that plans provide coverage for dependent students on medically necessary leaves of absence.

The standards will no longer let sponsors avoid complying with exclusion period limits, special enrollment period requirements or health status discrimination bans.

HHS says it will not take any enforcement actions with respect to opt-out elections for plan years beginning before April 1, 2011, on the provisions relating to preexisting condition exclusion period limits, special enrollment periods, and health status discrimination.


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