HHS Extends Transition Policy for Non-ACA Compliant Health PlansKelley M. Bendele
Due to President Donald Trump's executive order directing federal agencies to provide relief from the burdens of the ACA, HHS is now promoting the availability of these waivers.
HHS Extends Transition Policy for Non-ACA Compliant Health Plansntoscano50
On Feb. 29, 2016, the Department of Health and Human Services (HHS) extended an existing transition policy for certain health plans that do not comply with the Affordable Care Act (ACA) for an additional year, to policy years beginning on or before Oct. 1, 2017.
In states that allow it, this transition policy gives health insurance issuers the option of renewing current policies for current enrollees without adopting all of the ACA’s market reforms that took effect in 2014. Originally announced on Nov. 14, 2013, the transition policy was intended to apply in 2014 only. However, it was previously extended for two years, to policy years beginning on or before Oct. 1, 2016...
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
HHS Extends Transition Policy for Non-ACA Compliant Health PlansKelley M. Bendele
Due to President Donald Trump's executive order directing federal agencies to provide relief from the burdens of the ACA, HHS is now promoting the availability of these waivers.
HHS Extends Transition Policy for Non-ACA Compliant Health Plansntoscano50
On Feb. 29, 2016, the Department of Health and Human Services (HHS) extended an existing transition policy for certain health plans that do not comply with the Affordable Care Act (ACA) for an additional year, to policy years beginning on or before Oct. 1, 2017.
In states that allow it, this transition policy gives health insurance issuers the option of renewing current policies for current enrollees without adopting all of the ACA’s market reforms that took effect in 2014. Originally announced on Nov. 14, 2013, the transition policy was intended to apply in 2014 only. However, it was previously extended for two years, to policy years beginning on or before Oct. 1, 2016...
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
The Patient Protection and Affordable Care Act (Obama Care) provides opportunities for individuals and very small businesses to obtain affordable health insurance. More people will be covered in states like California which are expanding Medicaid (Medi-Cal) coverage. It is a complicated law but we hope that this presentation can give a suitable overview for the way the law is being implemented in the State of California.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
On Friday, August 6, 2010, BenefitMall hosted a Healthcare Reform Webinar. During the presentation, Sharon Alt covered Medical Loss Ratio, Dependant Coverage and Grandfathered Plans.
Summaries of Benefits & Coverage, Patient Protection Disclosures, Medicare Part D Creditable Coverage, Grandfathered Plan Notices, Model Exchange Notice, Health FSAs and COBRA Qualified Beneficiary Communications!
Each year Hr is required to provide employees with multipled notifications. Do you have a complete list of those requirements and when they are do? This list is here to help including the newest ACA notice requirements.
Understanding Wisconsins Health Plan Optionsnekiminurse
Wisconsin has been a leader in trying to provide low cost health insurance for those individuals who are unable to access or qualify for employer sponsored plans. This presentation was part of a kaizen event for clinic personnel on the prior authorization proccess.
To prepare for open enrollment, health plan sponsors should become familiar with the legal changes affecting plans for the 2014 plan year. In addition, health plan sponsors should make sure that open enrollment packages include certain participant notices.
Health Reform Bulletin 137 | Delay of Certain ACA Taxes and Fees; Benefit and...CBIZ, Inc.
On January 22, 2018, President Trump signed H.R. 195. Along with providing short-term government funding, it also extends funding of the Children's Health Insurance Program (CHIP) for six years through 2023. This program provides low-cost health coverage to children in families who do not qualify for Medicaid, as well as for pregnant women residing in certain states.
Although many key reforms of the Affordable Care Act (ACA) are effective for 2014, additional reforms will become effective in 2015 for employers sponsoring group health plans. For 2015, the most significant ACA change is the shared responsibility penalty for applicable large employers. To prepare for 2015, employers should review upcoming requirements and develop a compliance strategy. This Legislative Brief provides a health care reform checklist for 2015.
Health Care Reform -- 2016 Compliance Checklistntoscano50
The Affordable Care Act (ACA) has made a number of significant changes to group health plans since the law was enacted over four years ago. Many of these key reforms became effective in 2014 and 2015, including health plan design changes, increased wellness program incentives and the employer shared responsibility penalties.
Additional reforms take effect in 2016 for employers sponsoring group health plans. To prepare for 2016, employers should review upcoming requirements and develop a compliance strategy.
On Friday, August 6, 2010, BenefitMall hosted a Healthcare Reform Webinar. During the presentation, Sharon Alt covered Medical Loss Ratio, Dependant Coverage and Grandfathered Plans.
Summaries of Benefits & Coverage, Patient Protection Disclosures, Medicare Part D Creditable Coverage, Grandfathered Plan Notices, Model Exchange Notice, Health FSAs and COBRA Qualified Beneficiary Communications!
Each year Hr is required to provide employees with multipled notifications. Do you have a complete list of those requirements and when they are do? This list is here to help including the newest ACA notice requirements.
Understanding Wisconsins Health Plan Optionsnekiminurse
Wisconsin has been a leader in trying to provide low cost health insurance for those individuals who are unable to access or qualify for employer sponsored plans. This presentation was part of a kaizen event for clinic personnel on the prior authorization proccess.
To prepare for open enrollment, health plan sponsors should become familiar with the legal changes affecting plans for the 2014 plan year. In addition, health plan sponsors should make sure that open enrollment packages include certain participant notices.
Health Reform Bulletin 137 | Delay of Certain ACA Taxes and Fees; Benefit and...CBIZ, Inc.
On January 22, 2018, President Trump signed H.R. 195. Along with providing short-term government funding, it also extends funding of the Children's Health Insurance Program (CHIP) for six years through 2023. This program provides low-cost health coverage to children in families who do not qualify for Medicaid, as well as for pregnant women residing in certain states.
Recent Affordable Care Act (ACA) changes and impactsSrini Attili
Perspectives on recent Affordable Care Act (ACA) changes and impacts on industry - http://insights-on-business.com/healthcare/recent-affordable-care-act-aca-changes-and-impacts/
The Affordable Care Act (ACA) includes certain market reforms that apply to group health plans and health insurance issuers in the group and individual markets.
On Nov. 18, 2015, the Departments of Labor (DOL), Health and Human Services (HHS) and the Treasury (Departments) published final regulations regarding a number of the ACA’s market reform requirements.
Health Reform Bulletin 131 | The ACA Remains The Law of The LandCBIZ, Inc.
As has been covered extensively in the press, Congress went on its summer recess without repealing, replacing or modifying the Affordable Care Act. What this means for employers is that it is “business as usual”, including all reporting obligations, as more fully described below. So where does health care reform stand at this point? The answer to this question is far from clear.
Health Reform Bulletin: Implementation Guidance & ACA UpdatesCBIZ MHM, LLC
1) Distribution of Marketplace Notice to Employees; 2) 90-day Waiting Period; 3) Individual Shared Responsibility- Final Regulations; 4) Employer Appeals in Marketplace Eligibility Determinations; 5) Small Business Tax Credit; 6) Preventive Care - Health Saving Accounts; and 7) Internal Claims, Appeals and External Review: Providing Culturally and Linguistically Appropriate Notices
May 2017 Summary of the American Health Care Act T.docxalfredacavx97
May 2017
Summary of the American Health Care Act
This summary describes key provisions of H.R. 1628, the American Health Care Act, as approved by the House
of Representatives on May 4, 2017, as a plan to repeal and replace the Affordable Care Act (ACA) through the
Fiscal Year 2017 budget reconciliation process.
American Health Care Act
H.R. 1628
Date plan
announced
March 6, 2017; passed by the House of Representatives on May 4, 2017
Overall
approach
Repeal ACA mandates (2016), standards for health plan actuarial values (2020),
and, premium and cost sharing subsidies (2020).
Modify ACA premium tax credits for 2018-2019 to increase amount for younger
adults and reduce for older adults; allow tax credits to apply to coverage sold outside
of exchanges and to catastrophic policies. In 2020, replace ACA income-based tax
credits with flat tax credits adjusted for age. Eligibility for new tax credits phases out
at income levels between $75,000 and $115,000
Retain private market rules, including requirement to guarantee issue coverage,
prohibition on pre-existing condition exclusions, requirement to extend dependent
coverage to age 26. Modify age rating limit to permit variation of 5:1, unless states
adopt different ratios, effective 2018. Retain essential health benefits requirement,
with state option to waive. Retain prohibition on health status rating with state
option to waive for individual market applicants who have not maintained continuous
coverage.
Retain health insurance marketplaces, annual Open Enrollment periods (OE), and
special enrollment periods (SEPs).
Impose late enrollment penalty for people who don’t stay continuously covered.
Establish Patient and State Stability Fund with federal funding of $115 billion over
9 years available to all states, and additional funding of $8 billion over 5 years for
states that elect community rating waivers. States may use funds to provide financial
help to high-risk individuals, promote access to preventive services, provide cost
sharing subsidies, and for other purposes. In 2020, $15 billion of funds shall be used
only for services related to maternity coverage and newborn care, and mental health
and substance use disorders. [For 2018-2026, a further $15 billion is allocated
through the fund for Federal Invisible Risk Sharing Program (reinsurance). This
program is established as part of the fund, though administered by CMS to make
payments directly to health insurers.] In states that don’t successfully apply for
grants, funds will be used for reinsurance program.
Repeal funding for Prevention and Public Health Fund at the end of Fiscal Year
2018 and rescind any unobligated funds remaining at the end of FY 2018. Provide
supplemental funding for community health centers of $422 million for FY 2017
Encourage use of Health Savings Accounts by increasing annual tax free
co.
Are you ready for the upcoming 2014 provisions of the new healthcare reform act? Do you know what the implications are to you as a small or midsize company?
Our webinar will help you become familiar with upcoming requirements under the Patient Protection and Affordable Care Act.
Expect to learn the following and more:
What is the Patient Protection and Affordable Care Act
How does an organization determine their 2014 cost to comply?
What should organizations be doing now to prepare?
Although the Affordable Care Act has benefited the health insurance consumer in many respects, it has also added to the confusion. This presentation, Given by Wanda Stephens in Raleigh, North Carolina, details some of the many facets to Obamacare in NC.
for more information visit http://www.hisonc.com/obamacare-north-carolina/
Health Reform: Interim Guidance on Expatriate Plans; Updates on ACA Reportin...CBIZ, Inc.
This Health Care Reform Bulletin provides information on the following topics:
a. Interim Guidance on Expatriate Health Coverage
b. Updates on Section 6055/6056 Reporting
i. Revised and Increased Reporting Penalties
ii. E-filing requirements for Employers
c. Final Rules: Preventive Services
d. Reminder on PCOR Fees and Transitional Reinsurance
i. Checklist for PCOR and Transitional Reinsurance Fee
ACA Compliance Bulletin - Final Rule Expands Short-Term, Limited-Duration Ins...Kelley M. Bendele
Although short-term, limited-duration insurance is not an excepted benefit, it is specifically exempt from the definition of "individual health insurance coverage" and, therefore, is not subject to the ACA's market reform requirements.
Health Reform Bulletin 116 | Year-End Wrap Up Dec. 29, 2015CBIZ, Inc.
The government is winding up 2015 and ringing in 2016 with a bang. The final HRB of 2015 will keep you abreast of the various changes that occurred at the end of the year.
Health Reform Bulletin 116 Year End Wrap Up 12-29-15Daniel Michels
The most recent CBIZ Health Reform Bulletin: Year-End Wrap Up (HRB 116). This issue includes specific information and guidance on:
1. Late breaking development, IRS delays new Affordable Care Act's (ACA) reporting and disclosure obligations!
2. On December 18, 2015 Consolidate Appropriations Act, 2016, and the Protecting Americans from Tax Hikes (PATH) Act of 2015 (H. R. 2029; now Public Law No. 114-113) were signed by the President, and amend several provisions of the Affordable Care Act.
3. The IRS Issued guidance relating to ACA implementation
4. Year-End Reminders
Health Reform Bulletin – IRS PronouncementsCBIZ, Inc.
Information on 1) Cafeteria Plan Status Change Events, 2) Employment Status Change Proposals to Employer Shared Responsibility Rules, 3) Increase in PCOR Fees, and Final Excepted Benefit Regulations. Recently, the Internal Revenue Service (IRS) released three pronouncements relating to the Affordable Care Act (ACA). In addition, final regulations have been issued relating to certain excepted health benefits.
Health Reform Bulletin 135 | Repeal of Individual Penalty Mandate, Review of ...CBIZ, Inc.
While there has been much energy over the past year focused on repealing, replacing, or repealing and replacing the Affordable Care Act (ACA), the bulk of the law remains in full force and effect.
This notwithstanding, Congress passed the “Tax Cuts and Jobs Act” (H.R. 1) on December 20, 2017; the President is expected to sign the bill into law. This tax reform bill repeals the individual penalty mandate. As background, beginning in 2014, all individuals residing in the United States are required to maintain a minimum level of health coverage, or be subject to a tax penalty. This tax penalty will be repealed, effective for tax years beginning January 1, 2019.
Similar to ACA Compliance Bulletin - HHS Extends Transition Policy for Non-ACA Compliant Health Plans (20)
Compliance Bulletin - Washington Enacts Employee-paid Long-term Care ProgramKelley M. Bendele
Governor Jay Inslee signed a bill into law on May 13, 2019, that establishes a state-operated public insurance program to pay for long-term care services.
ACA Compliance Bulletin - Final Notice of Benefit and Payment Parameters for ...Kelley M. Bendele
In response to the White House announcing that it would no longer reimburse insurers for cost-sharing reductions made available to low-income individuals through the Exchanges, many issuers increased premiums in 2018 and 2019 only on silver level qualified health plans.
DOL audits can be triggered by negligence or mistakes on your part, or because your plan falls within one of the areas in which the DOL is focusing its investigative efforts.
Compliance Bulletin - Federal Court Strikes Down Association Health Plan RulesKelley M. Bendele
On March 28, 2019, a federal court stated that the final rule on association health plans was an "end-run" around the ACA and that the DOL exceeded its authority under ERISA.
ACA Compliance Bulletin - IRS Issues Letter 5699 to Noncompliant EmployersKelley M. Bendele
An ALE that fails to comply with the Section 6056 reporting requirements may be subject to penalties equal to $260 per violation for failure to file correct information returns by required deadlines.
ACA Compliance Bulletin - Affordability Percentages Will Increase for 2019Kelley M. Bendele
The updated affordability percentages, which are effective for taxable years and plan years beginning January 1, 2019, are significant increases from 2018.
Employers should ensure that their health FSA will not allow employees to make pre-tax contributions in excess of $2,650 for 2018, and they should communicate the new limit to their employees as part of the open enrollment process.
U.S. Justice Department Reverses Title VII Transgender PolicyKelley M. Bendele
The Department of Justice (DOJ) now takes the position that Title VII does not protect transgendered and other individuals from gender identity discrimination in the workplace.
On January 20, 2017, President Trump signed an executive order intended "to minimize the unwarranted economic and regulatory burdens" of the ACA until the law could be repealed and eventually replaced. However, the executive order does not include specific guidance regarding any particular ACA requirement or provision, and does not change any existing regulations.
Senate Republicans now plan to focus on repealing the ACA without a replacement plan, based on a budget reconciliation bill from 2015. This proposal would provide a two-year delay of the repeal to provide a stable transition period.
If the employer mandate is repealed, many ALEs will likely want to modify their plan designs to go back to pre-ACA eligibility rules. Employers may also consider increasing the amount that employees are required to contribute for group health plan coverage.
For 2018, Rev. Proc. 17-36 decreases the affordability contribution percentage to 9.56 percent. This means that employer-sponsored coverage will be considered affordable under the employer shared responsibility rules if the employee's required contribution for self-only coverage does not exceed 9.56 percent of the employee's household income for the tax year.
This infographic visually depicts five major consequences of adopting single-payer healthcare: eliminating upwards of 11 million U.S. jobs, forcing patients to wait for care, rationing prescription drugs, restricting research and development, and increasing taxes.
Because the cost-sharing limits for HDHPs will change for 2018, employers that sponsor these plans may need to make plan design changes for plan years beginning in 2018.
Unless a specific tax exemption applies, wellness incentives are generally subject to the same federal tax rules as any other employee rewards or prizes.
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and Beyond
ACA Compliance Bulletin - HHS Extends Transition Policy for Non-ACA Compliant Health Plans
1. Provided By:
eESI
HHS EXTENDS TRANSITION
POLICY FOR NON-ACA
COMPLIANT HEALTH PLANS
OVERVIEW
On April 9, 2018, the Department of Health and Human
Services (HHS) extended an existing transition policy for
certain health plans that do not comply with the Affordable
Care Act (ACA) for an additional year, to policy years
beginning on or before Oct. 1, 2019.
In states that allow it, health insurance issuers have the
option of renewing current policies for current enrollees
without adopting all of the ACA’s market reforms that took
effect in 2014. Originally announced in 2013, the transition
policy has already been extended several times.
IMPACT ON EMPLOYERS
Individuals and small businesses may be able to keep their
non-ACA compliant coverage through 2019, depending on
the plan or policy year.
This latest extension may also mean that ACA compliance is
never required for these transitional plans. If the ACA is
repealed, replaced or amended, the market reforms may no
longer apply to these plans.
HIGHLIGHTS
• HHS’ existing transition policy for
non-ACA compliant plans has been
extended for an additional year.
• If the state allows it, issuers can
renew noncompliant coverage
through 2019.
• Any plans that are renewed under
this extended transition policy must
end by Dec. 31, 2019.
IMPORTANT DATES
October 1, 2019
Certain non-ACA compliant plans may
continue to be renewed for policy years
beginning on or before Oct. 1, 2019.
December 31, 2019
All noncompliant plans renewed under
this extended transition policy cannot
extend past Dec. 31, 2019.
2. 2This Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.
Readers should contact legal counsel for legal advice.
Background
The ACA includes key reforms that created new coverage standards for health insurance policies, beginning in
2014. For example, effective for 2014 plan years, the ACA imposes modified community rating standards and
requires individual and small group policies to cover a comprehensive set of benefits.
Late in 2013, millions of Americans received notices informing them that their plans would be canceled
because they did not comply with the ACA’s reforms. President Barack Obama received criticism that these
cancellations went against his assurances that if consumers had a plan they liked, they could keep it.
Responding to pressure from consumers and Congress, on Nov. 14, 2013, President Obama announced a
transition relief policy for 2014 for non-grandfathered coverage in the small group and individual health
insurance markets. If permitted by their states, this transition policy gave health insurance issuers the option
of renewing current policies for current enrollees without adopting all of the ACA’s market reforms for 2014.
This transition policy was later extended several times.
The Latest Extension
On April 9, 2018, HHS extended this transitional policy for an additional year, to policy years beginning on or
before Oct. 1, 2019, provided that all policies end by Dec. 31, 2019. Under the extended transitional policy,
health coverage in the individual or small group market that meets certain criteria will not be considered to be
out of compliance with the ACA’s market reforms.
Specifically, the extended transition relief policy provides that:
States may allow issuers that have continually renewed
policies under the transitional policy since 2014 to
renew that coverage for a policy year starting on or
before Oct. 1, 2019; but
Any policies renewed under this transitional policy must
not extend past Dec. 31, 2019.
According to HHS, the additional one-year extension is intended to smoothly bring all non-grandfathered
coverage in the individual and small group markets into compliance with all applicable ACA requirements.
The extended transition relief only applies with respect to individuals and small businesses with coverage that
has been continually renewed since 2014, under the previous transition guidance. It does not apply with
respect to individuals and small businesses that obtained new coverage in 2014 or after. All new plans must
comply with the full set of ACA reforms.
Also, as required under the previous transition policy guidance, health insurance issuers that renew coverage
under this extended transitional policy must, for each policy year, provide a notice to affected individuals and
small businesses.
Health coverage in the individual
or small group market that meets
certain criteria will not be
considered to be out of compliance
with the ACA’s market reforms.
3. 3This Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.
Readers should contact legal counsel for legal advice.
Implementing the Extended Transition Relief Policy
HHS has stated that it will work with issuers and states to implement this extended transition policy, including
options such as allowing:
Policy years that are shorter (but not longer) than 12 months; or
Early renewals with a start date of Jan. 1, 2019.
According to HHS, this approach will facilitate smooth transitions from transitional coverage to ACA-compliant
coverage, which requires a calendar year policy year in the individual market.
States can elect to extend the transitional policy for shorter periods than outlined above, but may not extend
it beyond these periods. Also, states may choose to adopt the extended transitional policy:
• For both the individual and the small group markets;
• For the individual market only; or
• For the small group market only.
All transitional policies that have rate increases subject to review under the ACA should use the rules and
processes for submission to states and HHS that were updated April 9, 2018, to ensure compliance with the
ACA.
Notice to Affected Individuals and Small Businesses
As required under the previous transition policy guidance, health insurance issuers that renew coverage under
this extended transitional policy must, for each policy year, provide a notice to affected individuals and small
businesses.
HHS included two separate versions of the notice that must be used for this purpose in its guidance:
One for use when a cancellation notice has already been sent and the issuer is providing an option to
the policyholder to continue the existing coverage; and
One for use when a cancellation notice has not yet been sent and the issuer is providing an option to
the policyholder to continue the existing coverage.
According to HHS, these are required standard notices that cannot be modified. Issuers renewing coverage
under the extended transition policy must use one of the notices provided by HHS, as applicable.
State Decisions
Because the insurance market is primarily regulated at the state level, state governors or insurance
commissioners have to allow for the transition relief in their state.
4. 4This Compliance Bulletin is not intended to be exhaustive nor should any discussion or opinions be construed as legal advice.
Readers should contact legal counsel for legal advice.
A number of states decided against permitting insurers to use the original transition policy, including
California, Connecticut, Washington, Minnesota, New York, Vermont and Rhode Island. Some states, such as
Maryland, are allowing renewals with specific provisions.
Application to Large Employers
HHS’ previous guidance also included transition relief for large employers that had previously purchased
insurance in the large group market but that, as of Jan. 1, 2016, would have been redefined by the ACA as
small employers purchasing insurance in the small group market. At the option of the states and health
insurance issuers, these large employers had the option of renewing their current policies through policy years
beginning on or before Oct. 1, 2016, without their policies being considered to be out of compliance with the
specified ACA reforms that apply to the small group market but not to the large group market.
However, on Oct. 7, 2015, President Obama signed into law the Protecting Affordable Coverage for Employees
(PACE) Act, which repealed the ACA’s small group market expansion requirement. As a result, states now have
the option, but are not required, to expand their small group markets to include businesses with up to 100
employees.
Under HHS’ extended transition guidance for noncompliant plans, states that elect to expand the definition of
“small employer” to up to 100 employees may, under state law authority, choose to provide transition relief
to these employers, as appropriate.