Recently Issued ACA Final Rules Fold in Informal Guidance

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By Kristen Ricaurte Knebel

Nov. 18 — Recently released final rules on a host of Affordable Care Act issues close the gap between regulations and informal guidance in the form of answers to frequently asked questions that have been issued since the law's enactment.

“These are final rules that essentially incorporate a lot of FAQ guidance,” which closes “the loop” on these issues, Kathryn Wilber, senior counsel for health policy at the American Benefits Council, told Bloomberg BNA.

Incorporating previously issued sub-regulatory guidance into final rules isn't a new approach for the ACA's implementing agencies, Lisa M. Campbell, a principal with Groom Law Group Chartered in Washington, told Bloomberg BNA.

“This was consistent with the approach that we saw the departments take under mental health parity and also for the summary of benefits and coverage. I think this is how they've been approaching the interim final rules because they have put out so much sub-regulatory guidance over the past five years. This was their attempt to really get all of that into the regulations,” Campbell said.

The departments of Treasury, Labor and Health and Human Services issued final rules Nov. 13 that covered grandfathered health plans, pre-existing condition exclusions, lifetime and annual dollar limits on benefits, rescissions, coverage of dependent children to age 26, internal claims and appeals and external review processes, and patient protections. The rules were published in the Federal Register Nov. 18 (80 Fed. Reg. 72,192).

A good portion of the rules was expected and consistent with previous sub-regulatory guidance, Wilber said.

However, the agencies did make some changes, including a clarification that multiemployer plans adding a new contributing employer or a group of employees won't trigger a loss of grandfather status under the ACA, Gretchen K. Young, senior vice president of health policy at the ERISA Industry Committee, told Bloomberg BNA.

The final rules adopted a clarification on grandfather status that was addressed in the sixth set of answers to frequently asked questions that said a plan or coverage will no longer be considered grandfathered when an amendment to the plan terms becomes effective, regardless of the date the change was adopted, the rules said.

The rules also addressed annual and lifetime limits, saying that 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, Young said. 

For More Information

For more information, see Compensation and Benefit Library's “Tax Aspects of Health Plans Under the Affordable Care Act” chapter.

To contact the reporter on this story: Kristen Ricaurte Knebel in Washington at

To contact the editor responsible for this story: Jo-el J. Meyer at

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