Health Care Reform Update: State Exchange Rules Delayed

State Exchange Rules DelayedWe recently reported the delay of the “Play-or-Pay” Mandate which pushed to 2015 the need for employers to determine their status as an applicable large employer. After the Independence Day holiday, the Obama administration made an additional change related to state insurance marketplaces. According to Reuters, state exchanges now have until 2015 to begin random checks of enrollee’s employer-insurance status and only have to provide random – rather than comprehensive – check on income eligibility in 2014.

Beginning October 1 state exchanges begin open enrollment for individual plans that will be effective January 1. October 1 is also the deadline for employers to provide the “Notice to Employees of Coverage Options” which explains the state exchange options to individuals. The tax subsidies that would assist individuals to purchase on the exchanges have been set at household incomes between 100 percent and 400 percent of the federal poverty level and for individuals who do not have access to affordable insurance through an employer. According to the prior rules, the exchanges would have to do random checks to verify employer-sponsored benefits and comprehensive checks on enrollee’s income.

Final regulations released on Friday by the Department of Health and Human Services (HHS) are giving exchanges more time to put systems in place to provide these checks. Instead of random checks, the state-run exchanges could accept an enrollee’s “attestation regarding enrollment in an eligible employer-sponsored plan.” The rule also stated, “For income verification, for the first year of operations, we are providing (state and federal) exchanges with temporarily expanded discretion to accept an attestation of projected annual household income without further verification.”

 

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