HHS Issues Final Rule on PPACA's Indvidual Mandate

From Bloomberg Healthcare Blog


By Sara Hansard

People who can not afford to buy health insurance, or those who are ineligible for Medicaid based on a state's decision not to expand its program under the health care reform law, will not be fined for not having coverage under a final rule issued June 26 by the Department of Health and Human Services.


The HHS final rule on exemptions from the "shared responsibility" payments required by the Affordable Care Act was issued at the same time the Internal Revenue Service issued two related notices on transition relief from the fines and on eligibility for premium tax credit subsidies to help make coverage affordable.
Among the exemptions from the fine outlined in the HHS final rule (CMS-9958-F) is a provision excusing people if coverage offered by their employer does not meet the law's requirement for minimum value. The final rule also requires self-funded student health plans and state high-risk pools to qualify for minimum essential coverage for plan years beginning after 2014.
In 2012 the Congressional Budget Office (CBO) estimated that nearly 6 million people will have to pay about $7 billion in tax penalties under ACA because they lack health insurance in 2016. HHS cited the CBO report as well, saying that less than 2 percent of Americans are expected to owe the payments.

To view the entire final rule click here

Final Rules on Preventative Services Issueed

The Department of Labor's Employee Benefits Security Administration updated the Affordable Care Act information on its website with the following:

• Final rules regarding the Coverage of Certain Preventive Services, available at www.dol.gov/ebsa/pdf/coveragepreventiveservicesfinalrule.pdf


• HHS news release, available at http://www.hhs.gov/news/press/2013pres/06/20130628a.html

• HHS Fact Sheet: Affordable Care Act Rules on Expanding Access to Preventive Services for Women, available at http://www.hhs.gov/healthcare/facts/factsheets/2011/08/womensprevention08012011a.html

• HHS Fact Sheet: Women's Preventive Services Coverage and Non-Profit Religious Organizations, available at http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/womens-preven-02012013.html 

• Certification Form for Eligible Organizations: available at www.dol.gov/ebsa/preventiveserviceseligibleorganizationcertificationform.doc and www.dol.gov/ebsa/pdf/preventiveserviceseligibleorganizationcertificationform.pdf 

• Updated Guidance on the Temporary Enforcement Safe Harbor, issued June 28, 2013, available at http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/preventive-services-guidance-6-28-2013.pdf