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Washington Highlights

CMS Issues ACA Health Insurance Marketplace Reform Final Rule on Rate Review

March 8, 2013—The Centers for Medicare and Medicaid Services (CMS) Feb. 27 issued Health Insurance Market Rules; Rate Review. The final rule implements provisions of the Affordable Care Act (ACA, P.L. 111-148 and P.L. 111-152) related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans.  AAMC's comments on the rate review proposed rule focused on student health insurance, catastrophic health plans, and transparent rate review [see Washington Highlights, Dec. 28, 2012].  

Consistent with AAMC's comments, CMS finalized the proposal to exempt student health insurance coverage from the ACA’s guaranteed availability and guaranteed renewability requirements.  

Additionally, the final rule states that student health insurance coverage will not be subject to the single risk pool requirement that will apply to other plans.  These exceptions take into account the differences between the student health insurance market and other forms of individual coverage and will allow institutions of higher education to continue to meet their students’ needs by providing health insurance. 

CMS finalized standards for catastrophic health plans that will be available in the individual market to individuals under age 30 and to individuals who have been certified as exempt from the individual responsibility payment because they cannot afford minimum essential coverage or are eligible for a hardship exemption.  

These plans will not offer coverage at the ACA actuarial value levels and will not provide coverage of essential health benefits until the enrolled individual reaches the ACA’s annual limit on cost-sharing. Catastrophic plans will be required to cover at least three primary care visits per year before reaching the deductible and preventive services with A or B ratings from the USPSTF must be covered with no cost-sharing. 

With a few minor modifications, CMS finalized the sections of the proposed rule related to rate review as proposed.  To promote transparency, a state with an effective rate review program will have to make available on its website at least the same amount of information on each rate filing justification for increases over 10 percent that CMS makes available on its Web site. 


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

Allison M. Cohen, J.D., LL.M.
Senior Policy and Regulatory Specialist
Telephone: 202-862-6085

Jane Eilbacher
Policy and Regulatory Specialist
Telephone: 202-828-0896


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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