DHHS Offers Hardship Exemption from Tax Penalty to Certain Individuals

On May 2, 2014, the U.S. Department of Health and Human Services (DHHS) issued new guidance, entitled “Special Enrollment Periods and Hardship Exemptions for Persons Meeting Certain Criteria.” Under section 5000A of the Internal Revenue Code, beginning January 2014, nonexempt individuals who do not have minimum essential (health care) coverage (MEC) or who are not otherwise exempt are required to make a shared responsibility payment with their federal income tax returns. Section 5000A(e)(5) of the Code authorizes the Secretary of DHHS to determine hardship exemptions. [More]

CMS Issues Final Rule Affecting Home and Community-Based Services and Waivers

The Centers for Medicare and Medicaid Services (CMS) has issued a final rule, scheduled to be published in the Federal Register on January 16, 2014 and available online here, and on FDsys.gov, which amends the Medicaid regulations to define and describe state plan section 1915(i) home and community-based services (HCBS) under the Social Security Act as amended by the Affordable Care Act (ACA). [More]

HHS Proposes Quality Rating System for Exchange Health Plans

The U.S. Department of Health and Human Services published a notice in the Federal Register on November 19, 2013 proposing a quality rating system (QRS) for qualified health plans (QHPs) offered through health insurance Exchanges. The QRS is based on section 1311(c)(3) and (4) of the Affordable Care Act (ACA), which requires HHS to create a system enabling consumers to compare QHPs based on relative quality, price, and enrollee satisfaction. [More]

HHS Releases First Report on Enrollments in Health Plans Through Exchanges

The U.S. Department of Health and Human Services (HHS) released a report on November 13, 2013 indicating that, during the period October 1 – November 2, a total of 106,185 individuals had selected qualified health plans through health insurance Exchanges; 79,391 of those individuals selected a plan through a State-based Exchange in 15 States, including 35,364 in California alone (the report notes California’s exemplary, multi-lingual public outreach campaign), while only 26,794 did so through Federally-facilitated Exchanges in all other States. [More]

MT DPHHS Awards Affordable Care Act IV&V Project to PCG Technology Consulting

Sacramento, CA, September, 2013 – The Montana Department of Public Health and Human Services (DPHHS) recently awarded PCG Technology Consulting (PCG TC) a project to provide Independent Verification and Validation (IV&V) for the implementation of the Affordable Care Act (ACA). During the initial project phase, PCG TC will validate the DPHHS testing efforts in accordance with Centers for Medicare & Medicaid Services (CMS) requirements and issuing attestation letters. PCG TC will then provide ongoing IV&V services on a period basis as the DPHHS implements its enhanced integrated eligibility system [More]

HHS Proposes Rules on State Operated Basic Health Plans

The U.S. Department of Health and Human Services (HHS) published proposed rules in the September 25, 2013 Federal Register on state administration of optional “Basic Health Plans” (BHPs) authorized under section 1331 of the Affordable Care Act (ACA). This optional state program can be made available for state residents with household incomes between 133 percent and 200 percent of the Federal poverty level (FPL) who would otherwise be eligible to enroll in qualified health plans (QHPs) offered through Exchanges. States electing the BHP option may competitively procure two or more BHP plans, which may include fee-for-service or capitated plans. [More]

DHHS Releases Data on ACA Impact by State

On August 2, 2013, DHHS posted state-by state data on Affordable Care Act (ACA) benefits, including the percentage of individuals who will be eligible in each state to purchase health insurance coverage through the new exchanges.

For each state, the posting describes the percentage of uninsured who may be eligible for premium tax credits or expanded Medicaid coverage, the number of residents who will benefit from rebates under the ACA’s medical loss ratio, and how much was awarded to fund community health centers, among other details.


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HHS Finalizes Rules on Exchange/Medicaid Coordination

The U.S. Department of Health and Human Services (HHS) issued a draft final rule on July 5, 2013 on health insurance Exchange eligibility/enrollment procedures and Medicaid/CHIP eligibility notices, fair hearings, premiums, cost-sharing, and alternative benefit plans. The final rule is scheduled for official publication in the Federal Register on July 15, 2013. It allows State Medicaid agencies to delegate MAGI-related Medicaid eligibility determinations and appeals to the Exchange via a formal agreement if the Exchange is a government agency operating under a merit personnel system; and, if so, appellants must be given a choice whether to have their appeals heard at the State Medicaid agency or at the Exchange. [More]