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 HHS releases proposed rules fleshing out health law

By Paul Beddoe


In the first of what is expected to be a post-election flood of new regulations implementing aspects of the Affordable Care Act (ACA), the Department of Health and Human Services (HHS) released details of three new regulatory proposals on Nov. 20.

The rules govern market reforms designed to protect consumers, essential health benefits and new workplace wellness programs. Comments are due Dec. 26 with full implementation set for Jan. 1, 2014.

Bullet First Proposed Regulation

BulletSecond Proposed Regulation

Bullet Third Proposal Rule

BulletDear State Medicaid Director...

The first proposed regulation prohibits health insurance plans from denying coverage to individuals due to pre-existing or chronic conditions. Insurers would only be allowed to charge different premiums based on age, tobacco use, family size and geography. Denying coverage because of a pre-existing condition or charging higher premiums due to current or past health problems, gender, occupation and small employer size or industry would all be prohibited. The rule would allow young adults to buy a catastrophic coverage plan in the individual market.

The second proposed rule sets out the new essential health benefits standards — a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets, according to an HHS statement. Cindy Mann, the Medicaid program’s director, issued a companion “Dear State Medicaid Director” letter on implementing the essential health benefits in Medicaid to states. 

The third proposed rule expands workplace wellness programs to promote employee health and help rein in health care spending. At the same time, the proposal seeks to protect individuals from unfair underwriting practices that could otherwise reduce benefits based on health status.