The Centers for Medicare and Medicaid Services has sent to the Office of Management and Budget a final rule setting financial integrity and oversight standards for qualified health plans operating in state health insurance exchanges under the Affordable Care Act.
OMB review is one of the final steps before publication of a rule in the Federal Register. The rule is on a fast track, with federal officials continuing to insist that exchanges will be operational on Oct. 1, 2013, for open enrollment for health coverage in 2014. CMS published a proposed rule on June 19 with a quick 30-day public comment period.
Issues tackled under the proposed rule included cost-sharing reductions and advance payments of the premium tax credit, the Small Business Health Options Program, the single risk pool, quality standards, and risk adjustment, reinsurance and risk corridor programs; among others.
The rule also proposed additional standards for agents and brokers, geographic rating areas, guaranteed availability and renewability, special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys for payers, insurers participating in a federally-built exchange in states that declined to build their own, and state operations of a SHOP.
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