Federal Exchange Guidance

Updated Analysis on Essential Health Benefits

Joint California Comments on Essential Health Benefits Bulletin Submitted to Health and Human Services Secretary Sebelius:

The Exchange submitted comments jointly with the Department of Health Care Services, Department of Managed Health Care, Department of Insurance, and the Managed Risk Medical Insurance Board on the federal Essential Health Benefits Bulletin. The letter was informed by the Exchange board meetings and comments received.

Joint California Comment Letter on Essential Health Benefits Bulletin

Federal Government Releases Proposal for Essential Health Benefits:

On December 16, 2011, the federal government released an essential health benefits bulletin that included a proposal to permit states to select an existing plan to set the benchmark for items and services included in the essential health benefits package. Members of the public may submit comments about the proposal to the federal government until January 31, 2012. The bulletin may be accessed at:

http://cciio.cms.gov/resources/files/Files2/12162011/essential_health_benefits_bulletin.pdf

Federal Proposed Rules:

The federal government has issued—and will continue to issue—proposed regulations for various implementation aspects of the ACA—including the Exchange. The federal government refers to a proposed regulation as a “Notice of Proposed Rule Making. or “NPRM’”. Generally, an NPRM has two major portions,1) the preamble in which the promulgator explains what the NPRM is intended to do and sets forth areas where comments are particularly welcome and 2) the actual language of the proposed regulation. The federal government (usually the Department of Health and Human Services, but sometimes other departments) seeks comments on its NPRM which it then considers as it drafts the final rule. The due date for comment is usually 75 days after an NPRM is published in the federal register. You can access the NPRMs themselves on this website below:

The Exchange submitted comments on the Proposed Rules for Summary of Benefits and Coverage and the Uniform Glossary on October 21, 2011. Joint California comments on the other NPRMs and the Request for Information were submitted on October 31, 2011.

Comments on Notice of Proposed Rulemakings:

California Health Benefit Exchange Cover Letter and Comments on Proposed Rules for Summary of Benefits and Coverage and the Uniform Glossary (Submitted October 21, 2011)
Cover Letter – Comments on Establishment of Exchanges and Qualified Health Plans and Reinsurance, Risk Corridors, and Risk Adjustment NPRMs (Submitted October 31, 2011)
California Joint Comments on Proposed Rules for the Establishment of Exchanges and Qualified Health Plans (Submitted October 31, 2011)
California Joint Comments on Proposed Rules for Reinsurance, Risk Corridors, and Risk Adjustment (Submitted October 31, 2011)
Cover Letter – Comments on Health Insurance Premium Tax Credit; Exchange Functions in the Individual Market, Eligibility Determinations, and Exchange Standards for Employers; and Eligibility Changes to Medicaid NPRMs (Submitted October 31, 2011)
California Joint Comments on Proposed Rules for Premium Tax Credits (Submitted October 31, 2011)
California Joint Comments on Proposed Rules for Exchange Functions in the Individual Market; Eligibility Determinations; and Exchange Standards for Employers (Submitted October 31, 2011)
California Joint Comments on Proposed Rules for Medicaid Programs: Eligibility Changes under the Affordable Care Act of 2010

Comments on Request for Information:

California Joint Comments on Request for Information about the Basic Health Program (Submitted October 31, 2011)

Notice of Proposed Rulemakings:

August 22, 2011: Summary of Benefits and Coverage and the Uniform Glossary

August 17, 2011: ACA Exchange Functions in the Individual Market; Eligibility Determinations; Exchange Standards for Employers

August 17, 2011: Health Insurance Premium Tax Credit

August 17, 2011: Medicaid Program; Eligibility Changes Under the ACA

July 15, 2011: ACA Establishment of Exchanges and Qualified Health Plans

July 15, 2011: ACA Standards Relating to Reinsurance, Risk Corridors, and Risk Adjustment

July 20, 2011: ACA Establishment of Consumer Operated and Oriented Plan Program (CO-OP)