The U.S. Department of Health and Human Services (HHS) is getting ready to pump three major Patient Protection and Affordable Care Act (PPACA) regulation proposals into the Federal Register.
HHS published a 131-page proposed rule implementing PPACA health insurance market and rate review rules and a 119-page proposed rule implementing the PPACA essential health benefits (EHB), actuarial value and accreditation provisions.
On the same day, HHS joined with the U.S. Treasury Department and the U.S. Labor Department to publish an 81-page proposed rule implementing PPACA group health plan wellness program provisions.
HHS also is publishing other, related documents. For example, HHS will be publishing a brief notice stating that it is going ahead with previously announced plans to put the National Committee for Quality Assurance and URAC in charge of accrediting the “qualified health plans” (QHPs) that will be eligible to participate in the PPACA health insurance exchange program.
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Comments on the proposals HHS is posting by itself will be due 30 days after the official publication date. The comments on the wellness incentive regulations will be due 60 days after the publication date.
Some PPACA opponents are still fighting in Congress, in the courts, in state legislatures and in state agencies to kill PPACA or block implementation, but the U.S. Supreme Court ruled in June that Congress had the authority to pass a key PPACA provision, which would require many individuals to have a minimum level of health coverage. Voters voted President Obama back into office and expanded the Democrats’ majority in the Senate, apparently reducing Republicans’ ability to block or stall PPACA in Congress.
If PPACA takes effect on schedule and works as drafters expect, it will give individuals and small groups the ability to buy standardized coverage from QHPs through the new exchanges, or Web-based insurance supermarkets, by late 2013, with the coverage to start taking effect in 2014.
PPACA also is imposing many other new requirements, such as requirements that QHPs offer, at least, a standardized package of health benefits, or EHB package, and that QHPs provide one of four levels of coverage. A QHP’s “metal level” —platinum, gold, silver or bronze—is supposed to be based on the percentage of the actuarial value of the EHB that the plan covers.
Other PPACA provisions are supposed to take steps such as encouraging plans to make more use of wellness incentive prrograms.
The proposed regulations
In the rate review regulations, HHS officials said they want to support efforts to hold down health care costs.
Officials have included a provision for high-deductible “catastrophic plans” aimed both at individuals ages 30 and younger and at other uninsured individuals who have been certified as being exempt from the usual PPACA minimum coverage ownership mandate because they cannot afford the normal PPACA minimum level of coverage, or because they are eligible for a hardship exemption.
A catastrophic plan need not fit in with the usual metal level actuarial value requirements, and it need not have to cover the EHB package until the enrollee reaches the plan’s annual cost-sharing limit.
A catastrophic plan must cover three primary care visits a year even before the enrollee meets the deductible, but the plan can impose cost-sharing requirements on the use of the primary care visits, officials said in a preamble to the proposed regulations.
The proposed rate regulations also include a section on how to apply the PPACA “age banding” provisions, which permit plans to charge the oldest enrollees three times as much as they charge the youngest enrollees.
In the proposed wellness incentive program regulations, officials at HHS, Treasury and Labor emphasize that most PPACA wellness incentive antidiscrimination rules apply only to programs that reward employees based on performance on actual health measures, such as improvements in weight or blood pressure, and not to programs that simply encourage employees to participate in “participatory wellness” activities, such as exercise classes.
The antidiscrimination rules are meant to encourage employers to use “health contingent” wellness incentives, by spelling out the rules, not to discourage use of the incentives, officials said.
Wellness incentive rules now let health plans use incentives with a value equal to up to 20 percent of the cost of the underlying health coverage.
HHS and the other departments now want to increase the maximum value of the incentives to 30 percent of the cost of the health coverage. The maximum for a program that includes programs designed to prevent or decrease tobacco use would be 50 percent, officials said.