On August 9, 2013, the Centers for Medicare and Medicaid Services (CMS) released guidance on State Alternative Applications for Health Coverage through the Small Business Health Options Program (SHOP). Beginning October 1, 2013, the new SHOP marketplaces will use applications to determining eligibility for participation in SHOP and enrollment in qualified health plans through the SHOP. In May 2013, CMS released model applications for shop coverage, but state-based SHOPs may also use an alternative SHOP application as approved by CMS. This guidance provides background on the development process, review, and approval of alternative SHOP applications.

States may submit SHOP applications for approval, and the alternative applications must meet the general principles of the model applications by adhering to regulations implementing the Affordable Care Act. Some aspects of the application will require formal approval. But there are also a number of ways a state can adopt the model applications without formal approval as an alternative application. For example, states can add state SHOP program names and contact information to the application, change the visuals of the application for proper branding, add language to the privacy statement, or remove questions about text messaging. Moreover, no approval is required for some modifications that minimize consumer burden.Continue Reading CMS Issues Guidance on Alternative SHOP Applications

On July 10, 2013, the Center for Medicare and Medicaid Services (CMS) released a “Frequently Asked Question” response regarding CCIIO assessment fees. The question asked “Can States collect assessment fees in their first year of Exchange operations for use in the second year of operations?” The response explained that States can decide to collect assessment

The Centers for Medicare and Medicaid Services (CMS) issued a final rule on May 31, 2013, effective July 31, 2013, regarding the Small Business Health Options Program (SHOP) under the Affordable Care Act (ACA).

The ACA permits individuals and small businesses to purchase private health insurance through Health Insurance Marketplaces; section 1311(b)(1)(B) of the ACA

On May 30, 2013, the Centers for Medicare and Medicaid Services (CMS) issued a “Frequently Asked Questions” document regarding MLR Reporting Requirements. The new question addresses so-called “fixed indemnity” policies that fail to meet the criteria for fixed indemnity policies under the Affordable Care Act Implementation FAQs from January 2013. The question asked whether issuers