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On February 27, 2015, the federal Department of Health and Human Services published the Notice of Benefit and Payment Parameters for 2016 Final Rule, which included several provisions pertaining to form review. This analysis, prepared by the Georgetown University Health Policy Institute’s Center on Health Insurance Reforms, provides a brief summary of the key provisions specific to form review and other notable provisions specific to the 2016 plan year.

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Date Created: Apr 6, 2015
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Federal regulations state that in order to be certified as a Qualified Health Plan in a Federally-facilitated marketplace, plans must be considered “meaningfully different” from all other plans in their subgroup. This document, prepared by the Georgetown Health Policy Institute’s Center on Health Insurance Reforms, is intended to help insurance regulators to understand meaningful difference standards and the ways in which they are applied by CMS.

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Date Created: Mar 23, 2015
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Excepted benefits and short-term, limited-duration insurance are insurance products that are exempted from the Affordable Care Act’s (ACA) consumer protections. Recent questions from several states have indicated that some confusion exists about which insurance products qualify as “excepted benefits” and are therefore exempt from several requirements of the ACA, such as coverage for preventive health services, a prohibition on lifetime limits, and minimum value requirements…

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Date Created: Jan 23, 2015
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As health care costs rise, one of the chief determinants of the rate of increase has been the cost of prescription drugs. Over time, additional tiers have been included in pharmacy benefit designs and, as they were added, cost sharing in the new, higher tiers has increased.

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Date Created: Aug 15, 2014
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As the 2015 open enrollment period approaches, one of the most significant challenges faced by marketplaces stems from the complicated nature of premium subsidy calculations, which may lead to potentially large swings in consumers’ after-subsidy premiums and tax liability implications.

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Date Created: Aug 7, 2014
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The State Network hosted a Small Group Convening in Boston, MA on July 10-11, 2014, bringing together state officials and technical experts to discuss QHP and IAP renewals in advance of the upcoming open enrollment period. The meeting provided officials from several states within and outside of State Network an opportunity to discuss strategies for confronting potential issues related to the renewals process.

Date Created: Jul 18, 2014
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Manatt Health Solutions, with support from the State Network, has prepared a high level summary of the tasks that states must accomplish to achieve certification of a State Partnership Exchange for Plan Management and/or Consumer Assistance. These tasks closely track the Blueprint for Approval of Affordable State-based or State Partnership Insurance Exchanges, with detailed annotations of tasks directly from the Blueprint.

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Date Created: Nov 13, 2012
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The following chart, prepared by Manatt Health Solutions, with support from the State Network, summarizes the federal statutory and regulatory eligibility and enrollment requirements for Medicaid using the Modified Adjusted Gross Income (MAGI) methodology, CHIP, Non-MAGI Medicaid, Temporary Assistance for Needy Families (TANF), Child Care Assistance Program and Supplemental Nutrition Assistance Program (SNAP).

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Date Created: Oct 13, 2012
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Health insurance exchanges are the vehicle through which millions of Americans will gain access to coverage beginning in 2014. The U.S. Department of Health and Human Services (HHS) released its initial proposed rules on exchange implementation on July 11, 2011.

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Date Created: Aug 11, 2011
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Under the Affordable Care Act (ACA) much of the expanded coverage will be provided through health insurers offering products on the new health insurance exchanges. To ensure robust markets, exchanges must have in place processes for mitigating the financial risk to insurers associated with enrolling individuals with diverse health care needs.

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Date Created: Aug 11, 2011