The rule, available here and being published on Dec. 7, is one of the major components supporting the state health insurance exchanges that are expected to be operational by October 2013, although that date may be delayed.
The rule covers risk adjustment, reinsurance and risk corridors programs to stabilize premiums; cost-sharing reductions and advance payments of the premium tax credit to assist low- and moderate-income consumers in affording coverage via an exchange; user fees levied on payers to support the exchanges; the Small Business Health Option Program to increase insurance options; and the medical loss ratio program to control insurer administrative costs.
The permanent risk adjustment, reinsurance and risk corridor programs provisions in the proposed rule “fill in the framework established by the Premium Stabilization Rule” that was finalized in March 2012, according to CMS.
Overall, “the provisions of this proposed rule, combined with other provisions in the Affordable Care Act, will improve the individual insurance market by making insurance more affordable and accessible to millions of Americans who currently do not have affordable options available to them,” CMS contends in the proposed rule.
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