The U.S. Department of Health and Human Services (HHS) has finalized regulations designed to help stabilize the individual and small group health insurance markets and, in particular, the health insurance exchanges established under the Affordable Care Act (ACA) in 2018.

The final rules, issued in expedited fashion, generally follow the proposed regulations and include changes such as:

  • Advancing by one year a change that shortens the period for annual enrollment in health insurance exchange coverage; it will now last from November 1–December 15.
  • Requiring all mid-year special enrollment elections in health insurance exchanges to be verified as appropriate.
  • Allowing insurers to collect certain past-due premiums from individuals who terminate coverage and reenroll within one year.
  • Providing for greater flexibility in the rules that establish the metal levels of exchange coverage.
  • Easing certain requirements for network plans.

The new rules recognize the authority of states to determine network adequacy and grant states that administer their own exchanges flexibility in verifying special enrollment elections. The new rules also provide that the collection of past-due premiums is subject to state law.

In the commentary to the regulations, HHS acknowledges that an administrative mechanism will need to be established to notify consumers and otherwise implement the changes. Perhaps more significantly, the commentary makes several references to the cost-sharing reductions that are available to low-income individuals who obtain coverage through a health insurance exchange. In view of concerns expressed about whether the current administration will continue these cost-sharing reductions, references to these subsidies as an ongoing feature of exchange coverage may be significant.

With the change in administrations, changes are expected for the ACA and a range of other laws and regulations affecting health care and health benefits. Ballard Spahr attorneys established the Health Care Reform Initiative to monitor and analyze legislative and regulatory developments. We will continue to follow developments in this area as they emerge. Changes may come to the Health Care Reform Dashboard, but it will continue to serve as an online resource center for news and analysis on developments regarding the ACA and health care reforms that follow.

Attorneys in Ballard Spahr’s Employee Benefits and Executive Compensation Group help clients design and implement compensation and benefits packages that comply with today’s complex regulatory requirements, attract and retain a quality workforce, and maintain fiscal and fiduciary responsibility.