On July 5, 2013, the Department of Health and Human Services issued a final rule on various provisions of the Affordable Care Act, including essential health benefits in alternative benefit plans, eligibility notices, fair hearing and appeals processes, premiums and cost sharing, and eligibility verification by exchanges. In part, the final rule delays implementation of the HHS eligibility verification service for advance payments of premium tax credit and cost-sharing reductions past the first year of operations (2014), and it clarifies that the option to rely on HHS to perform the verification is effective for eligibility determinations that are effective on or after January 1, 2015. Please note, however, that HHS also states that it “plan[s] to continue working closely with Exchanges, and may propose regulatory amendments as necessary, to implement an increasingly effective verification process over time.” Further, the final rule delays the date by which an exchange must implement sample-based review. With regard to eligibility determinations for advance payments of premium tax credit and cost-sharing reductions effective before January 1, 2015, the final rule provides that an exchange may accept the applicant’s attestation regarding enrollment in an eligible employer-sponsored plan and eligibility for qualifying coverage in an eligible employer-sponsored plan for the benefit year in which coverage is requested, without further verification.
The full text of the final rule is available here.