Overview of the August 29, 2013 Final Rule on Program Integrity: Exchange, SHOP, and Eligibility Appeals

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 August 29, 2013, the U. S. Department of Health and Human Services (HHS) issued a final rule on Program Integrity: Exchange, SHOP, and Eligibility Appeals. This rule finalizes Exchange standards on eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. In addition, it establishes standards for a state’s operation of the Exchange and Small Business Health Options Program (SHOP). This document provides a high-level summary of these rules and highlights key changes to the regulation since the issuance of the proposed rule.