September 2013 – Health Care Reform Developments

Final Regulations on the Individual Mandate

The IRS issued final regulations on the requirement that, starting in 2014, individuals must have minimum essential health insurance coverage or be subject to a shared responsibility penalty. The regulations, which generally finalize proposed regulations issued earlier this year, define minimum essential coverage, explain who is exempt from the individual mandate, and describe how the penalty is calculated and paid.

Proposed Regulations on the Small Employer Health Insurance Credit

The IRS issued proposed regulations on the small employer health insurance credit. The proposed regulations generally incorporate the provisions of IRS Notices 2010-44 and 2010-82 as modified to reflect the differences between the statutory provisions applicable to years before 2014 and those applicable to years after 2013. 

Final Regulations on the State Insurance Marketplaces

HHS released final regulations on a number of provisions related to the Affordable Care Act. The overarching goal of the regulations, which generally finalize proposed regulations issued earlier this year, is to safeguard federal funds and to protect consumers by ensuring that issuers, the insurance marketplaces, and other entities comply with federal standards meant to ensure consumers have access to quality, affordable health insurance. The rules finalize, among other things, standards for the handling of consumer complaints by issuers in the insurance marketplaces, and other provisions meant to ensure smooth operation of the insurance marketplaces, protect consumers, and give flexibility to states. The rules explain the process for employers to contest a determination that they do not provide minimum essential coverage that is affordable and provides minimum value, individuals to appeal eligibility determinations for marketplace participation and insurance affordability programs, and employers and employees to appeal denials of eligibility to purchase coverage through the small business health options program (SHOP).