Two healthcare reform regulations move forward
Despite the ongoing attempts of Republicans to repeal President Obama's health reform law and link it to the current scandal at the Internal Revenue Service, the administration is going ahead with two major Affordable Care Act regulations that provide insurance to people with pre-existing conditions and set maximum profit margins for certain providers.
The rules for both regulations will be published this week in the Federal Register, according to the The Hill's RegWatch blog post.
Beginning in 2014, all Americans, regardless of their health status, will have access to affordable health insurance either through their employer or new competitive marketplace exchanges. The regulation prohibits insurers from charging more or denying coverage to anyone with preexisting conditions, such as diabetes, asthma or cancer.
To bridge the gap until the provision in the law takes effect, the government has created a Pre-Existing Condition Insurance Plan program that provides access to health insurance. But the costs to fund the temporary program were higher than projected, according to RegWatch, so the interim final rule will set new, lower reimbursement to healthcare providers participating in the program.
The regulation, set to take effect mid-June, also prevents providers from balance billing patients for the difference in payment.
In addition, the administration also will publish a medical-loss ratio final rule capping profit margins for certain health insurance plans and prescription drug benefit programs, RegWatch reported. The measure, which takes effect in January 2014, calls for plans that deliver services under Medicare Advantage and the Medicare Prescription Drug Benefit program to spend at least 85 percent of their premiums on clinical services, prescription drugs, quality improvement activities and direct benefits to beneficiaries. Overhead expenses and profits will be capped at 15 percent.
To learn more:
- see the Pre-Existing Condition Insurance Plan Program interim final rule
- read the medical-loss ratio final rule
- check out the RegWatch post
- read the fact sheet about the Pre-Existing Condition Insurance Plan Program
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