With President Obama’s re-election and gains by Democrats in both the House and the Senate last month, implementing decisions and regulations for the Patient Protection and Affordable Care Act (PPACA) are regaining momentum.
Initially, states had until November 16, 2012, to declare whether they will run their own insurance exchanges, rely on exchanges created by federal agencies or do a combination of both. In a post-election decision, HHS officials granted states an extension – but only until December 14, 2012 – to submit exchange plan blue-prints. HHS will approve or conditionally approve state-based exchange plans by January 1, 2013. Exchanges must be ready for enrollment on October 1, 2013.
An updated list of state decisions is maintained by the Kaiser Family Foundation and by the Center on Budget and Policy Priorities. It shows that, as of November 19, 2012, 17 states and the District of Columbia plan to operate their own exchanges, 16 will allow federal operation, six will partner with federal authorities and 11 remain undecided.
A host of additional regulations and clarifications are expected in the coming months. The LHSFNA will monitor and report on these as they are released. Check the Fund’s Health Care Reform Updates page.
In the meantime, as discussed in a recent webcast by the International Foundation of Employee Benefit Plans (IFEBP), health & welfare fund trustees and administrators should be aware of this list of plan mandates issued so far:
| If Grandfathered… | If Not Grandfathered… |
|---|---|
| Coverage for children to age 26 (2011) | All mandates for grandfathered plans, plus: |
| No lifetime dollar limits on essential health benefits (EHB) (2011) | Preventive care at $0 cost-sharing (now) |
| Restricted annual dollar limits on EHB | Patient protections (now) |
| No preexisting condition exclusions for children under 19 (2011) | Internal appeals/external reviews (now) |
| Limitations on rescissions (2011) | No discrimination in favor of highly compensated employees (HCEs) (insured plans only) (delayed) |
| Summary of benefits and coverage (2012-2013) | Quality reports (2013?) |
| No annual dollar limits on EHB (2014) | Maximum deductibles and out-of-pocket limits (2014) |
| No preexisting condition exclusions for any participant (2014) | No discrimination against participants in clinical trials (2014) |
| No waiting periods > 90 days (2014) | No provider discrimination (2014) |
| Cover EHB (2014) (insured plans only) |
[Steve Clark]
