HHS finalizes more Obamacare policies - KCTV5 News

HHS finalizes more Obamacare policies

By Adam Aigner-Treworgy, CNN White House Producer
updated 8:14 PM EDT, Wed Aug 28, 2013

WASHINGTON (CNN) -- As part of its continued effort to solidify Affordable Care Act regulations before insurance exchanges open on October 1, the Department of Health and Human Services finalized a new rule on Wednesday clarifying how a number of issues will be handled in the new marketplaces.

"The overarching goal is to safeguard federal funds and to protect consumers by ensuring that issuers, marketplaces, and other entities comply with federal standards meant to ensure consumers have access to quality, affordable health insurance," the department said in a press release.

One issue addressed by HHS is the appeals process for Americans who feel they should qualify for coverage or federal support under the individual insurance exchange but have been deemed ineligible by the government. In its release, HHS sketched out a "federally managed appeals process" where individuals will first go through a preliminary review and receive what the department is calling an "informal resolution." If the consumer is satisfied with the outcome, that decision would be viewed as final, but if not they may request a more formal hearing.

Consumers in state-based marketplaces may first be subject to a state-specific appeals process, but can ultimately appeal to the federal government if they're unhappy with the state's decision.

Wednesday's release also outlines a separate appeals process for employers looking to appeal the government's assessment of the insurance plans they currently offer. Under the Affordable Care Act, all plans must meet federal standards for "minimum essential coverage." If the government determines that plans offered by a company don't meet those standards, under the new rules the employer may appeal that determination through either a state-run or federal process.

HHS also finalized a policy pertaining to oversight and privacy protection. While state insurance regulators will continue to provide primary oversight, the new rules allow HHS to monitor companies that offer plans on the new exchanges, in addition to the exchanges themselves, to make sure they're in compliance with federal standards. In order to be eligible to offer plans on the exchanges, the new rule also dictates that insurers must accept multiple forms of payment, including paper checks, cashier's checks, money orders, electronic transfers and prepaid debit cards, and according to HHS, they must "present all payment method options equally."

The government also released a final decision that would allow states that have chosen to default to a federally run individual insurance exchange to nonetheless set up a state-run exchange for businesses, called a Small Business Health Options Program. If the state can assure the government that its small-business exchange is up to federal standards, the rules released Wednesday say they can begin operating in 2014.


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