Agencies Finalize Vault of ACA Regs and Informal Guidance



The departments of Treasury, Labor and Health and Human Services issued final rules codifying interim, temporary and sub-regulatory guidance on Affordable Care Act implementation. 

Issued Nov. 13, the final rules cover grandfathered plans, preexisting condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals, and patient protections under the ACA.

Since the ACA was enacted in 2010, the three agencies have issued regulations implementing the law in several phases. These phases have included interim final regulations, temporary regulations, proposed regulations and XXIX sets of frequently asked questions interpreting and clarifying the regulations.  

While the agencies did make some changes, these final rules mostly adopt previously published guidance and make no major changes to the interim rules.  

Aspects of the final rules include: 

  • Grandfathered plans. Multiemployer plans that add a new contributing employer or a group of employees won't trigger a loss of grandfather status.
  • Preexisting condition exclusions. Plans that choose to exclude a benefit for a condition from the plan, regardless of when the condition arose relative to the effective date of coverage, is not a preexisting condition exclusion.
  • Lifetime and annual limits. Group health plans that aren't required to provide essential health benefits must use one of the 51 base-benchmark plans chosen by the states and the District of Columbia, or the federal employee health benefit plan, to determine which benefits can't be subject to annual and lifetime limits.
  • Rescissions. The agencies clarify situations in which a retroactive cancellation or discontinuance of coverage is not a rescission.
  • Dependent coverage. HMOs with plan design that includes service area restrictions may not impose such restrictions to covered dependents up to age 26.
  • Appeals. The transition period for states to meet the NAIC (Uniform Model Act)-parallel external review process standards is extended through December 31, 2017.
  • Patient protections. Plans and issuers are permitted to apply reasonable geographic limitations when determining which primary care providers to make available for selection.  

The final rules (RIN  0938-AS56) were issued Nov. 13 and published in the Federal Register (80 Fed. Reg. 72,192) Nov. 18. They apply to group health plans and health insurance issuers beginning on the first day of the first plan year, or individual market policy year, beginning on or after Jan. 1, 2017. 

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