The federal government is once again extending pre-2014 health plans and outlining other tweaks and finalized rules for several key programs that regulators hope will smooth what continues to be a bumpy and confusing transition.
Following last November's decision to let states decide whether to extend non-Affordable Care Act compliant health plans for one year -- to meet President Obama's "if you like your health plan, you can keep it" promise -- the federal government is giving states at least another two years, through 2016, to continue plans that would have been cancelled.
"We will consider the impact of the two-year extension of the transitional policy in assessing whether an additional one-year extension is appropriate," wrote Gary Cohen, the director of CMS's Center for Consumer Information and Insurance Oversight, in a guidance summarizing the changes.
This "transitional policy" also applies to large businesses that in 2016 will be redefined as small businesses and required to buy small group policies.
"At the option of the states and health insurance issuers, they, too, will have the option of renewing their current policies through policy years beginning on or before October 1, 2016, without their policies being considered to be out of compliance," wrote Cohen, who also announced, separate from the guidance, that he's departing the agency.
State governors and insurance regulators are being given a fair amount of flexibility for the policy: they can extend the policies for less than two years, or only extend individual or small group plans, as well as both. Twenty eight states ended up deciding to extend pre-2014 plans, including Florida, Illinois and Pennsylvania.
Simplifying the complex
CMS and the Treasury Department outlined a number of other changes and tentative timelines aimed at offering a consolidated summary of complex regulations that have confused some industry players and employers and inflamed existing controversies over the ACA.
In a joint statement, the agencies said the "comprehensive release of regulations and policies responds to the concerns we've heard from families, states, businesses, health professionals, Congress, insurance commissioners, and insurers who want certainty on what's coming as early as possible so that they can plan ahead."
As the ACA's first enrollment period comes to a close this month, CMS is planning enrollment for the 2015 plan year, tentatively setting it at November 15 through February 15, a month longer than previously planned. States will have until June 15 to decide whether they want to create their own exchanges.
CMS regulators are also tweaking the ACA's reinsurance and risk corridor programs in a batch of final rules. They're lowering the reinsurance attachment point for 2014 from $60,000 to $45,000 in claims per person and raising it to $70,000 for 2015, with a cap of $250,000 per person, and promising that the risk corridor market stabilization program will be budget neutral. Self-insured and self-administered plans will also be exempt from the reinsurance fee in 2015 and 2016.
CMS is increasingly annual limits for cost-sharing in 2015 year exchange policies, from $6,400 to $6,600 in individual plans and from $12,700 to $13,200 in family policies.
And they're also getting ready for the small business health options (or SHOP) program, the web-version of which was delayed in 2014 along with the employer mandate.
A new final rule will allow employers in states with federally-run exchanges to offer single stand-alone dental plans or a choice of dental plans at different benefit levels. After the 2015 plan year, employers will also be able to offer different amounts of premium contributions to full-time and part-time employees. Under the final rule, states HIX SHOPs will be able to start selling small group plans through web-based brokers like eHealth Insurance.
"We are also considering proposing that states could recommend modifications to the provision that allows employees to choose any plan within a coverage level if doing so would preserve and promote affordable insurance for employees and small businesses," CMS regulators wrote.
Reporting requirements
Meanwhile, from the Treasury Department, come an attempt at "simplifying and streamlining reporting requirements for employers." While something like 95 percent of employers won't be subject to the ACA's reporting requirements because they're small businesses with fewer than 50 people on staff, those that are -- representing far more than 5 percent of the American workforce -- have been fretting over new administrative mandates.
Under the final rules, self-insured employers will be able to report to the Internal Revenue Service using a single form consolidating sections 6055 and 6056 of the tax code. Large employers buying full insurance need to only complete one section of that form, for section 6056, and insurers will report for section 6055. Insurers do not have to report on members for plans sold through public exchanges, since the IRS will be able to gather information on enrollment directly from the exchanges, Treasury's announcement noted.
As for employers dealing with the issue of "qualifying offers" of affordable coverage to full-time employees, the new system tries to streamline reporting of what would have been monthly, employee-specific information.
For employees with coverage offers for all 12 months of the year, employers will need to report their names, addresses, and taxpayer identification numbers and note that they received the offer. For employees with an offer for fewer than the whole year, employers only need to enter a code to indicate the offer was made.
In an additional attempt at simplifying the process, under the final regulations employers have the option of not identifying which employees are full-time "and instead to just include in the report those employees who may be full-time," the Treasury Department said.