New ACA Regulations “Start Setting the Stage”

Yesterday, November 20, the bell rang.  CMS issued its proposed rule on insurance exchanges and their requirements.  CMS essentially has reaffirmed what the ACA requires.  This is not unexpected, but it demonstrates how the “sturm and drang” of the dialogue pre-2012 election has now officially been replaced with a certain normality as the proposed rules are released, reviewed, and then made final.  Don’t expect these proposed rules to change much.
The quick take-aways are:

  • Whether state or federally run, or a mix, the all-important insurance exchanges will not be able to deny coverage and will not be able to charge certain types of patients (women, people with pre-existing conditions) more for coverage.  Remember – CMS just gave the states an additional four (4) weeks to consider to what extent they wish to have the federal government involved in running their individual state exchanges.
  • One of the “quid pro quos” of the ACA – that as the number of covered lives is increased, other types of payments to hospitals for caring for the uninsured (e.g. the DSH payments) fade away over time – remains unchanged and is now on track.
  • In the exchanges, insurers will have to cover 10 “basic” health care benefits – such as ER care, maternity care, prescriptions, and hospital stays.

It will be interesting to see in what direction states that have not yet made a choice as to their exchange model choose to go.