New PPACA Implementation Regulations Released

July 10, 2013

pic-healthHHS has released a new 606 page final rule implementing parts of the Patient Protection and Affordable Care Act (PPACA).  It is expected that it will be published in the Federal Register on July 15th.

The rule addresses the Medicaid and Children’s Health Insurance programs, eligibility notices, the appeals process, premiums and cost sharing, and exchange eligibility and enrollment.

Perhaps the most notable aspect of the final rule is a provision that would, for the first year of exchange operations, instruct the exchanges to accept an individual’s attestation of projected annual household income without further verification, notwithstanding the underlying law that requires the exchanges and insurers to verify household income with the Internal Revenue Service for purposes of the determining the correct amount of premium subsidy a person should receive.  In its discussion, the Department of Health and Human Services (HHS) basically states that verification as contemplated by the PPACA is not feasible by Oct. 1, 2013 when the exchanges are required to be operational.  Individuals will be required to reconcile the premium subsidy they received with the amount they were actually entitled to on their annual tax returns.

To read the final HHS rule, click here.