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Washington Highlights

HHS Issues Proposed Regulations on Health Insurance Exchanges, Essential Health Benefits, and Wellness Programs

November 30, 2012—The Department of Health and Human Services (HHS) Nov. 26 published a series of proposed rules that implement provisions of the Affordable Care Act.  The proposed rule, “Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation,” outlines proposed standards for health insurance issuers in the small group and individual markets.  The proposed rule also outlines the standards for states relative to the establishment of health insurance exchanges; exchange functions; and Qualified Health Plans.  The proposals do not apply to Medicaid benchmark or benchmark-equivalent plans.  Proposals for those plans will be issued in a separate rule. Comments on the proposed rule are due Dec. 26.

A second proposed rule issued by HHS, “Health Insurance Market Rules; Rate Review,” is designed to prevent insurance companies from discriminating against people with pre-existing conditions. Generally, health insurers would be prohibited from denying coverage to people because of a pre-existing condition or any other factor. Health insurers would be required to maintain a single statewide risk pool for each of their individual and small employer markets, unless a state decides to merge these two pools into one pool. Comments on the proposed rule are due Dec. 26.

The third proposed rule, “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,” implements and expands employer wellness programs. The proposed rule, issued by the departments of Health and Human Services, Labor, and Treasury, sets requirements to protect consumers from unfair practices when “health-contingent programs” are implemented.  These programs generally require individuals to meet a specific standard related to their health to obtain a reward.  Comments are due Jan. 25, 2013, and the rules would be effective for plan years starting on or after Jan. 1, 2014.


Ivy Baer, J.D., M.P.H.
Senior Director and Regulatory Counsel
Telephone: 202-828-0499


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Washington Highlights, a weekly electronic newsletter, features brief updates on the latest legislative and regulatory activities affecting medical schools and teaching hospitals.

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806