Download or read book Patient Protection and Affordable Care ACT Health Insurance Market Rules Rate Review Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Health Insurance Market Rules - Rate Review (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Health Insurance Market Rules - Rate Review (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are non-federal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS). This book contains: - The complete text of the Patient Protection and Affordable Care Act - Health Insurance Market Rules - Rate Review (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Benefit and Payment Parameters for 2019 Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 282 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth payment parameters and provisions related to the risk adjustment and risk adjustment data validation programs; cost-sharing parameters; and user fees for Federally-facilitated Exchanges and State Exchanges on the Federal platform. It finalizes changes that provide additional flexibility to States to apply the definition of essential health benefits (EHB) to their markets, enhance the role of States regarding the certification of qualified health plans (QHPs); and provide States with additional flexibility in the operation and establishment of Exchanges, including the Small Business Health Options Program (SHOP) Exchanges. It includes changes to standards related to Exchanges; the required functions of the SHOPs; actuarial value for stand-alone dental plans; the rate review program; the medical loss ratio program; eligibility and enrollment; exemptions; and other related topics. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2019 (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Program Integrity Exchange Shop and Eligibility Appeals Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This document contains interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Benefit and Payment Parameters for 2018 Amendments to Special Enrollment Periods Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 250 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2018 - Amendments to Special Enrollment Periods (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2018 - Amendments to Special Enrollment Periods (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule sets forth payment parameters and provisions related to the risk adjustment program; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges and State-based Exchanges on the Federal platform. It also provides additional guidance relating to standardized options; qualified health plans; consumer assistance tools; network adequacy; the Small Business Health Options Programs; stand-alone dental plans; fair health insurance premiums; guaranteed availability and guaranteed renewability; the medical loss ratio program; eligibility and enrollment; appeals; consumer-operated and oriented plans; special enrollment periods; and other related topics. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Benefit and Payment Parameters for 2018 - Amendments to Special Enrollment Periods (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Preexisting Condition Exclusions Lifetime and Annual Limits Rescissions and Patient Protections Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 128 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This document contains interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preexisting condition exclusions, lifetime and annual dollar limits on benefits, rescissions, and patient protections. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Program Integrity Exchange Premium Stabilization Programs and Market Standards Amendments to HHS Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards - Amendments to HHS (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards - Amendments to HHS (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, this final rule outlines financial integrity and oversight standards with respect to Affordable Insurance Exchanges, qualified health plan (QHP) issuers in Federally-facilitated Exchanges (FFEs), and States with regard to the operation of risk adjustment and reinsurance programs. It also establishes additional standards for special enrollment periods, survey vendors that may conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in an FFE, and makes certain amendments to definitions and standards related to the market reform rules. These standards, which include financial integrity provisions and protections against fraud and abuse, are consistent with Title I of the Affordable Care Act. This final rule also amends and adopts as final interim provisions set forth in the Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 interim final rule, published in the Federal Register on March 11, 2013, related to risk corridors and cost-sharing reduction reconciliation. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Program Integrity - Exchange, Premium Stabilization Programs, and Market Standards - Amendments to HHS (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Establishment of Consumer Operated and Oriented Plan Program Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Establishment of Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Establishment of Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule implements the Consumer Operated and Oriented Plan (CO-OP) program, which provides loans to foster the creation of consumer-governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges (Exchanges). The goal of this program is to create a new CO-OP in every State in order to expand the number of health plans available in the Exchanges with a focus on integrated care and greater plan accountability. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Establishment of Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule specifies additional options for annual eligibility redeterminations and renewal and re-enrollment notice requirements for qualified health plans offered through the Exchange, beginning with annual redeterminations for coverage for benefit year 2015. This final rule provides additional flexibility for Exchanges, including the ability to propose unique approaches that meet the specific needs of their state, while streamlining the consumer experience. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Annual Eligibility Redeterminations for Exchange Participation and Insurance Affordability Programs (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This interim final rule with comment establishes provisions that alter the parameters of select special enrollment periods and that revise certain rules governing consumer operated and oriented plans (CO-OPs). This book contains: - The complete text of the Patient Protection and Affordable Care Act - Amendments to Special Enrollment Periods and the Consumer Operated and Oriented Plan Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Patient Protection and Affordable Care ACT Establishment of Exchanges and Qualified Health Plans Small Business Health Options Program Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-10 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patient Protection and Affordable Care Act - Establishment of Exchanges and Qualified Health Plans - Small Business Health Options Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Patient Protection and Affordable Care Act - Establishment of Exchanges and Qualified Health Plans - Small Business Health Options Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act) related to the Small Business Health Options Program (SHOP). Specifically, this final rule amends existing regulations regarding triggering events and special enrollment periods for qualified employees and their dependents and implements a transitional policy regarding employees' choice of qualified health plans (QHPs) in the SHOP. This book contains: - The complete text of the Patient Protection and Affordable Care Act - Establishment of Exchanges and Qualified Health Plans - Small Business Health Options Program (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book The Affordable Care Act written by Tamara Thompson and published by Greenhaven Publishing LLC. This book was released on 2014-12-02 with total page 130 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Patient Protection and Affordable Care Act (ACA) was designed to increase health insurance quality and affordability, lower the uninsured rate by expanding insurance coverage, and reduce the costs of healthcare overall. Along with sweeping change came sweeping criticisms and issues. This book explores the pros and cons of the Affordable Care Act, and explains who benefits from the ACA. Readers will learn how the economy is affected by the ACA, and the impact of the ACA rollout.

Download or read book Ninety Day Waiting Period Limitation Certain Health Coverage Requirements Under the Affordable Care ACT Us Department of Health and Human Services Regulation Hhs 2018 Edition written by The Law The Law Library and published by Createspace Independent Publishing Platform. This book was released on 2018-11-09 with total page 70 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ninety-Day Waiting Period Limitation - Certain Health Coverage Requirements Under the Affordable Care Act (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) The Law Library presents the complete text of the Ninety-Day Waiting Period Limitation - Certain Health Coverage Requirements Under the Affordable Care Act (US Department of Health and Human Services Regulation) (HHS) (2018 Edition). Updated as of May 29, 2018 These final regulations implement the 90-day waiting period limitation under section 2708 of the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act), as amended, and incorporated into the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code. These regulations also finalize amendments to existing regulations to conform to Affordable Care Act provisions. Specifically, these rules amend regulations implementing existing provisions such as some of the portability provisions added by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) because those provisions of the HIPAA regulations have become superseded or require amendment as a result of the market reform protections added by the Affordable Care Act. This book contains: - The complete text of the Ninety-Day Waiting Period Limitation - Certain Health Coverage Requirements Under the Affordable Care Act (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section

Download or read book Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act ACA Issues for Congress written by Suzanne M. Kirchhoff and published by Createspace Independent Pub. This book was released on 2012-10-20 with total page 32 pages. Available in PDF, EPUB and Kindle. Book excerpt: The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) requires certain health insurers to provide rebates to their customers for each year that the insurers do not meet a set financial target called a medical loss ratio (MLR). At its most basic, a MLR measures the share of a health care premium dollar spent on medical benefits, as opposed to company expenses such as overhead or profits. For example, if total premiums collected are $100,000, and $85,000 is spent on medical care, the MLR would be 85%. The ACA sets the minimum required MLR at 80% for the individual and small group markets and at 85% for the large group market. In general, the higher the MLR, the more value a policyholder receives for his or her premium payment. Congress imposed the MLR in an effort to provide “greater transparency and accountability around the expenditures made by health insurers and to help bring down the cost of health care.” Insurers that fail to meet these minimum standards must provide rebates to policyholders. The Department of Health and Human Services (HHS), with input from state insurance commissioners who are the main regulators of health insurance, issued rules for implementing the provisions. These rules provided greater details for calculating the MLR and issuing rebate payments. ACA allows companies to include quality improvements along with medical benefits when calculating the MLR. In addition, state and local taxes and some licensing fees are subtracted (i.e., disregarded) from expenses in the MLR formula. ACA's requirements are different from those imposed by state laws, which generally compare only medical claims to premiums. Though a number of states have their own MLRs, the ACA is now the minimum standard that must be met nationwide by certain health insurers. About 12.8 million U.S. consumers were due more than $1.1 billion in ACA MLR rebate payments in August 2012, for an average award of $151 per qualifying household. Employers or insurers can provide the rebates, which are based on activity in 2011, via a check, an electronic deposit in a bank account, a reduction in future insurance premiums in the amount of the rebate, or by spending the funds for the benefit of employees. About 66.7 million people were insured by covered companies that met or exceeded MLR standards for 2011, and will not receive rebates. The MLR is based on the aggregate performance of a health plan, not individual policy history. Even if a beneficiary had no medical claims during a given year, he or she would not receive a rebate if the broader plan met the MLR requirements. In addition, many Americans were enrolled in health plans that were not covered by the ACA MLR provisions in 2011. The ACA MLR provisions cover only fully funded health plans, which are plans where insurance companies assume the full risk for medical expenses incurred. The requirements do not extend to self-funded plans, which are health care plans offered by businesses in which the employer assumes the risk for, and pays for, medical care. Non-profit insurers and some Medicare Advantage plans were not covered by the ACA MLR standards in 2012, though the MLR provisions will be phased in during 2013 and 2014, respectively. In addition, some states won special exceptions for individual insurance policies, based on a HHS determination that meeting the MLR requirement would harm a state's insurance market. Several issues have been raised about the MLR provisions since the ACA was enacted. These include considerations regarding the treatment of insurance agent and broker bonuses and commissions, the impact of the MLR on insurers that provide high deductible plans, and special rules for non-profit health insurers.

Download or read book Health Care Utilization as a Proxy in Disability Determination written by National Academies of Sciences, Engineering, and Medicine and published by National Academies Press. This book was released on 2018-04-02 with total page 161 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.

Download or read book Section 1557 of the Affordable Care Act written by American Dental Association and published by American Dental Association. This book was released on 2017-05-24 with total page 10 pages. Available in PDF, EPUB and Kindle. Book excerpt: Section 1557 is the nondiscrimination provision of the Affordable Care Act (ACA). This brief guide explains Section 1557 in more detail and what your practice needs to do to meet the requirements of this federal law. Includes sample notices of nondiscrimination, as well as taglines translated for the top 15 languages by state.

Download or read book The Affordable Care Act and Health Insurance Markets written by Christine Eibner and published by Rand Corporation. This book was released on 2013-08-29 with total page 117 pages. Available in PDF, EPUB and Kindle. Book excerpt: In this report, the authors estimate the effects of the Affordable Care Act on health insurance enrollment and premiums for ten states (Florida, Kansas, Louisiana, Minnesota, New Mexico, North Dakota, Ohio, Pennsylvania, South Carolina, and Texas) and for the nation overall, with a focus on outcomes in the nongroup and small group markets.

Download or read book Private Health Insurance Market Reforms in the Patient Protection and Affordable Care Act ACA written by Annie L. Mach and published by Createspace Independent Pub. This book was released on 2012-07-28 with total page 30 pages. Available in PDF, EPUB and Kindle. Book excerpt: The private health insurance provisions in the Patient Protection and Affordable Care Act (P.L. 111-148, ACA, as amended) include market reforms that impose requirements on private health insurance plans. Such reforms relate to the offer, issuance, generosity, and pricing of health plans, among other requirements. ACA's market reforms largely focus on the individual and small group health insurance markets, and in this report the reforms have been grouped by effective dates: “immediate” market reforms that become effective prior to the full implementation date of ACA, and reforms that become effective on the full implementation date (January 1, 2014). ACA requires implementation of a number of reforms prior to its full implementation date (i.e., prior to plan years beginning on or after January 1, 2014). “Immediate” reforms include a process to review unreasonable rate increases; an Internet portal to assist consumers in identifying coverage options; prohibition on lifetime limits and restriction of annual limits; the prohibition on rescissions; coverage of preventive health services with no cost-sharing; extension of dependent coverage; prohibition of discrimination based on salary; standards related to medical loss ratios and rebates to plan participants; appeals process; coverage of preexisting health conditions for children; patient protections; uniform explanation of coverage documents; and reporting requirements regarding quality of care. Market reforms effective beginning in 2014 include nondiscrimination based on health status; guaranteed issue and guaranteed renewability; coverage of preexisting health conditions (regardless of age); nondiscrimination regarding clinical trial participation; rating restrictions; waiting period limitation; and nondiscrimination regarding health care providers. This report provides background information about the private health insurance market, including market segments and regulation. It describes each ACA market reform and notes any major implementation activity that has occurred (e.g., issuance of final rule from a department such as Health and Human Services). The appendices of the report provide additional information about the status of regulations relating to each reform and how the reforms apply to the different market segments and health plans.