Friday, March 1, 2013

HHS Publishes Final Regulation on Reinsurance Program

On Friday, March 1, HHS published a final rule that includes the final regulations for the Temporary Reinsurance Program under the ACA.  Upon publication of the proposed rule, NBCH submitted a comment letter on behalf of our members commending HHS for proposing flexible standards and options for counting plan enrollees, but expressed concern about the unanswered questions still remaining such as treatment of disease management and wellness programs, and the interaction between the TRP and state high-risk pools.

The final rule reiterates that the reinsurance contribution applies to enrollees in "major medical coverage."  The following exclusions to major medical coverage are clarified by HHS:

  • stand-alone vision and dental
  • plans that cover prescription drugs only
  • stand-alone HRAs and HSAs
  • employee assistance, wellness, and disease management programs, to the extent they do not provide major medical coverage
  • stop-loss and reinsurance policies

Several commenters requested that retiree-only coverage be excluded, but HHS maintains that it does not have the statutory authority to do so.

In the final rule, HHS clarifies that states cannot collect additional funds beyond those required to administer the ACA TRP from ERISA-covered self-insured health plans.  States are still allowed to operate their own high-risk pools outside of the ACA program, but these states cannot collect contributions from self-insured employers whose plans are covered under ERISA.

The final regulation indicates that future guidance on the mechanics of submitting the TRP payments is forthcoming.  NBCH will continue to monitor agency activity on this program.

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