Overview of October 24, 2013 Final Rule on Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards

Abstract

Since the enactment of the Affordable Care Act in 2010, there has been consistent federal guidance employing and clarifying its provisions. Hilltop develops regulation summaries to assist state and local policymakers in their implementation of health reform. On October 24, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule on Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014. This final rule outlines financial integrity and oversight standards for Exchanges and qualified health plan (QHP) issuers, and the operation of state risk adjustment and reinsurance programs. In addition, this final rule clarifies standards for special enrollment periods, survey vendors that conduct enrollee satisfaction surveys on behalf of QHP issuers, and issuer participation in the federally facilitated Exchange (FFE). This document provides a high-level summary of these rules and highlights key changes to the regulation since the issuance of the proposed rule.