Territories Get a Break from the ACA

The Obama administration said last week that certain health care arrangements in five US territories would not have to comply with the ACA’s major insurance requirements, including guarantee issue, modified community rating, rate review, and medical loss ratio requirements. Territories will have to return unspent funds but can keep grant money already spent to prepare for the law. The territories had raised concerns that complying with the law’s insurance reforms in the absence of its individual mandate and insurance subsidies is destabilizing their insurance markets. The exemption applies to Puerto Rico, Guam, U.S. Virgin Islands, Northern Mariana Islands and American Samoa.

Regulators last week responded to the Supreme Court’s Hobby Lobby court’s ruling with Frequently Asked Question (FAQ) guidance requiring ERISA plans of closely-held firms to specify in their SPDs if the plan excludes any contraceptive services. The FAQ reminds sponsors that plans which reduce or stop such coverage after providing it generally must inform their participants within 60 days after adopting the plan change. The guidance came as the Senate failed to advance a bill (S 2578) offered by Democrats that would require employers to cover contraception regardless of their religious beliefs.

This week in Congress, a House panel will hold hearings examining the impact of the ACA on Medicare Advantage and whether the Department of Health and Human Services has sufficient capability to ensure that subsidies are not improperly provided or susceptible to fraud.

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