Regulations and Guidance

• Consumer Support and Information
  • External Appeals
  • Summary of Benefits and Coverage and Uniform Glossary
• Content Requirements for Healthcare.gov
• Pre-Existing Condition Insurance Plan (PCIP)
• Early Retiree Reinsurance Program (ERRP)
• Affordable Insurance Exchanges
  • Plan Management
• Minimum Acceptable Risk Standards
• Premium Stabilization Programs
• State Innovations
• Consumer Operated and Oriented Plans Program
• Health Market Reforms
  • Regulations
  • Annual Limits
  • Association Coverage
  • Coverage for Young Adults
  • Employer Responsibility
  • Grandfathered Plans
  • Medical Loss Ratio
  • Patient’s Bill of Rights
  • Prevention
  • Review of Insurance Rates
  • Student Health Plans
• Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Consumer Support and Information

External Appeals

Regulations

• July 23, 2010
  OCIIO-9993-IFC: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act - Opens in a new window (PDF – 257 KB)
• June 22, 2011
  CMS-9993-IFC2: Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes - Opens in a new window
• July 26, 2011
  CMS-9993-CN: Group Health Plans and Health Insurance Issuers: Rules Relating to Internal Claims and Appeals and External Review Processes; Correction - Opens in a new window (PDF - 184 KB)

 Guidance

• August 26, 2010
  Notice: Availability of Interim Procedures for Federal External Review and Model Notices Relating to Internal Claims and Appeals and External Review Under the Patient Protection and Affordable Care Act - Opens in a new window
• August 26, 2010
  Technical Guidance: Interim Procedures for Federal External Review Relating to Internal Claims and Appeals and External Review For Health Insurance Issuers in the Group and Individual Markers and under the Patient Protection and Affordable Care Act (PDF – 51 KB)
• September 1, 2010
  Technical Guidance: Issuers in the Individual Market to Establish County Level Estimates Pertaining to the Culturally and Linguistically Appropriate Standards Set Forth in the Internal Claims and Appeals and External Review Processes under the Patient Protection and Affordable Care Act (PDF – 26 KB)
• September 20, 2010
  Guidance: Interim Procedures for Internal Claims and Appeals under the Patient Protection and Affordable Care Act (PDF – 29 KB)
• September 23, 2010
  Technical Guidance: Interim Procedures for Federal External Review Relating to Internal Claims and Appeals and External Review under the Patient Protection and Affordable Care Act for Self-Insured Non-Federal Government Health Plans (PDF – 17 KB)
• March 18, 2011
  Technical Guidance: Extension of Non-Enforcement Period Relating to Certain Interim Procedures for Internal Claims and Appeals under the Patient Protection and Affordable Care Act - Opens in a new window
• June 22, 2011
  Technical Release 2011-02: Guidance on External Review for Group Health Plans and Health Insurance Issuers Offering Group and Individual Health Coverage, and Guidance for States on State External Review Processes (PDF – 381 KB)
• June 22, 2011
  Technical Guidance- June 22, 2011: Updated Instructions for Calculating County Level Estimates Pertaining to the Culturally and Linguistically Appropriate Standards Set Forth in the Internal Claims and Appeals and External Review Processes under the Affordable Care Act (PDF - 54 KB)
• June 22, 2011
  Technical Guidance- June 22, 2011: Instructions For Self-Insured Nonfederal Governmental Health Plans and Health Insurance Issuers Offering Group and Individual Health Coverage on How To Elect a Federal External Review Process (PDF – 46 KB)
• August 17, 2012
  Technical Guidance: Content of Notices – Adverse Benefit Determinations and Final Internal Adverse Benefit Determinations for Beneficiaries in Non-Federal Governmental Health Plans (PDF – 64 KB )
• March 15, 2013
  Technical Guidance: Extension of the Transition Period for the Temporary NAIC-Similar State External Review Process under the Affordable Care Act (PDF - 208 KB)

Summary of Benefits and Coverage and Uniform Glossary

Regulations

• August 22, 2011
  CMS-9982-P: Summary of Benefits and Coverage and the Uniform Glossary - Opens in a new window
• February 14, 2012
  CMS-9982-F: Summary of Benefits and Coverage and Uniform Glossary - Opens in a new window

 Guidance

• August 22, 2011
  Notice: Summary of Benefits and Coverage and Uniform Glossary - Templates, Instructions, and Related Materials under the Public Health Service Act - Opens in a new window
• February 14, 2012
  Summary of Benefits and Coverage and Uniform Glossary - Templates, Instructions, and Related Materials, and Guidance for Compliance - Opens in a new window

Content Requirements for HealthCare.gov

Regulations

• May 5, 2010
  Health Care Reform Insurance Web Portal Requirements (PDF – 368 KB)

Guidance

• May 3, 2010
  Memorandum: User Access and Authorization for the Health Insurance Oversight System

Pre-Existing Condition Insurance Plan (PCIP)

Regulations

• July 30, 2010
  OCIIO–9995­–IFC: Pre-Existing Condition Insurance Plan Program - Opens in a new window (PDF – 198 KB)
• August 30, 2012
  CMS–9995–IFC2: Pre-Existing Condition Insurance Plan Program - Opens in a new window

Guidance

• October 6, 2010
  The Pre-Existing Condition Insurance Plan Program and Newborn Coverage (PDF – 105 KB)
• December 28, 2010
  Portability of Coverage, Enrollee Notices, and Third Party Payments (PRD – 57 KM)
• February 17, 2011
  Eligibility for Children under Age 19 in the Federally-Administered Pre-Existing Condition Insurance Plan (PDF – 166 KB)
• March 23, 2011
  Pre-Existing Condition Insurance Plan Eligibility and Access to Other Creditable Coverage (PDF – 145 KB)
• May 31, 2011
  PCIP Premium and Benefit Revisions(PDF – 31 KB)
• May 31, 2011
  Question and Answer Regarding Anti-Dumping Provisions Related to the Pre-Existing Condition Insurance Plan Program (PDF – 13 KB)
• May 25, 2012
  Management of PCIP Program in 2012 (PDF - 75 KB) 

Early Retiree Reinsurance Program (ERRP)

Regulations

• May 5, 2010
  Early Retiree Reinsurance Program (PDF – 132 KB)
• December 13, 2011
  CMS-9996-N2: Early Retiree Reinsurance Program Notice regarding Incurred Claims Date - Opens in a new window
• March 21, 2012
  CMS-9996-N3: Early Retiree Reinsurance Program Notice regarding the Date by which Plan Sponsors Must Use Funds - Opens in a new window
• April 23, 2013
   CMS-9996-N4: Early Retiree Reinsurance Program Notice regarding Termination of Several Operational Processes - Opens in a new window  

Affordable Insurance Exchanges

Regulations

• July 15, 2011
  CMS-9989-P:Establishment of Exchanges and Qualified Health Plans - Opens in a new window (PDF - 425 KB)
• August 17, 2011
  CMS-9974-P: Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers - Opens in a new window (PDF - 319 KB)
• August 17, 2011
  CMS-2349-P: Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010 - Opens in a new window (PDF - 394 KB)
• August 17, 2011
  REG-131491-10: Health Insurance Premium Tax Credits - Opens in a new window (PDF - 247 KB)
• September 30, 2011
  Patient Protection and Affordable Care Act: Establishment of Exchanges and qualified Health Plans and Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment: Extension of Comment Period - Opens in a new window (PDF - 143 KB)
• March 16, 2012
  Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-FWP) and Standards Related to Reinsurance Risk Corridors and Risk Adjustment (CMS-9975-F) (PDF - 315 KB)
• March 27, 2012
  CMS-9989-F: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers - Opens in a new window (PDF - 906 KB)
• May 29, 2012
  CMS-9989-CN: Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Correction - Opens in a new window
• January 14, 2013
  CMS-2334-P: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals - Opens in a new window
• January 30, 2013
  CMS-9958-P: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions - Opens in a new window
• March 11, 2013
  CMS-9964-P2: Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program - Opens in a new window
• April 3, 2013
  CMS-9955-P: Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel - Opens in a new window

Guidance

• November 3, 2010
  Guidance: Exchange and Medicaid Information Technology (IT) Systems (PDF -110 KB)
• November 18, 2010
  Guidance: Initial Guidance to States on Exchanges
• May 31, 2011
  Guidance: Guidance for Exchange and Medicaid Information Technology (IT) Systems: Version 2.0 (PDF – 401 KB)
• November 29, 2011
  State Exchange Implementation Questions and Answers (PDF – 135 KB)
• April 26, 2012
  Verification of Access to Employer-Sponsored Coverage Bulletin (PDF - 122 KB)
• May 16, 2012
  General Guidance on Federally-facilitated Exchanges (PDF – 196 KB)
• December 10, 2012
  Exchanges, Market Reforms and Medicaid Frequently Asked Questions (PDF – 251 KB)
• January 3, 2013
  Guidance on State Partnership Exchange (PDF – 226 KB)
• March 1, 2013
  Draft 2014 Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF - 450 KB)
• April 5, 2013
  2014 Letter to Issuers on Federally-facilitated and State Partnership Exchanges (PDF - 430 KB)
• May 1, 2013
  Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces (PDF - 507 KB)
• May 10, 2013
  Small Business Health Options Program (SHOP)-Only Marketplace  (PDF - 34 KB)

Plan Management

Regulations

• June 5, 2012
  CMS-9965-P: Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans - Opens in a new window
• July 18, 2012
  CMS-9965-F: Data Collection to Support Standards Related to Essential Health Benefits; Recognition of Entities for the Accreditation of Qualified Health Plans - Opens in a new window
• November 26, 2012
  CMS-9961-N: Recognition of Entities for the Accrediation of Qualified Health Plans - Opens in a new window
• November 26, 2012
  CMS-9980-P: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation - Opens in a new window
• February 20, 2013
  CMS-9980-F: Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation - Opens in a new window

Guidance

• December 16, 2011
  Essential Health Benefits Bulletin (PDF - 104 KB)
• January 25, 2012
  Essential Health Benefits: Illustrative List of the Largest Three Small Group Products by State (PDF – 135 KB)
• February 17, 2012
  Frequently Asked Questions on the Essential Health Benefits Bulletin (PDF – 88 KB)
• February 24, 2012
  Actuarial Value and Cost-Sharing Reductions Bulletin (PDF - 123 KB)
• July 2, 2012
  Essential Health Benefits: List of the Largest Three Small Group Products by State (PDF – 183 KB)
• January 28, 2013
  Issuers of Stand-alone Dental Plans (PDF - 223 KB)
• February 20, 2013
  State Evaluation of Plan Management Activities of Health Plans and Issuers (PDF - 35 KB)
• April 12, 2013
  Companion Guide for the Enrollment Transaction Information Version 1.5 (PDF - 1 MB)

Minimum Acceptable Risk Standards

Guidance:

• August 1, 2012
  Harmonized Security and Privacy Framework – Exchange Reference Architecture Supplement V1.0  (PDF – 487 KB)
  Minimum Acceptable Risk Standards for Exchanges – Exchange Reference Architecture Supplement, V1.0  (PDF - 185 KB)
  Catalog of Minimum Acceptable Risk Controls for Exchanges – Exchange Reference Architecture Supplement, V1.0  (PDF - 1,994 KB)
  ACA System Security Plan Procedures, V1.0  (PDF - 194 KB)
  ACA System Security Plan Template, V1.0 - editable  (DOC - 220 KB)
  ACA System Security Plan Template, V1.0  (PDF - 492 KB)
  ACA System Security Plan Workbook, V1.0 –editable  (DOC - 1,532 KB)
  ACA System Security Plan Workbook, V1.0  (PDF - 1,518 KB)
  ACA Safeguard Procedure Report Template, V1.0 (DOC - 378 KB)

Premium Stabilization Programs

Regulations

• July 15, 2011
  CMS-9975-P: Standards Related to Reinsurance, Risks Corridors and Risk Adjustment - Opens in a new window (PDF - 281 KB)
• July 15, 2011
  CMS-9989-P2: Preliminary Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-P) and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (CMS-9975-P) (PDF – 204 KB)
• March 16, 2012
  Regulatory Impact Analysis: Establishment of Exchanges and Qualified Health Plans (CMS-9989-FWP) and Standards Related to Reinsurance, Risk Corridors and Risk Adjustment (CMS-9975-F) (PDF – 315 KB)
• March 23, 2012
  CMS-9975-F: Standards Related to Reinsurance, Risks Corridors and Risk Adjustment - Opens in a new window (PDF - 336 KB)
• December 7, 2012
  CMS-9964-P: HHS Benefit and Payment Parameters for 2014, and Medical Loss Ratio - Opens in a new window
• March 11, 2013
  CMS-9964-F: HHS Benefit and Payment Parameters for 2014 - Opens in a new window
• March 11, 2013
  CMS-9964-IFC: Amendments to the HHS Notice of Benefit and Payment Parameters for 2014 - Opens in a new window

Guidance

• May 1, 2012
  Bulletin on the Risk Adjustment Program: Proposed Operations by the Department of Health and Human Services (PDF – 207 KB)
• May 31, 2012
  Bulletin on the Transitional Reinsurance Program: Proposed Payment Operations by the Department of Health and Human Services (PDF – 187 KB)
• May 7, 2013
  HHS-Developed Risk Adjustment Model Algorithm Software
  • Instructions (PDF - 249 KB)
  • Technical Details (XLSX - 567 KB)
• SAS Version of HHS-Developed Risk Adjustment Model Algorithm Software (ZIP - 567 KB)

State Innovations

Regulations

• March 10, 2011
  Application, Review, and Reporting Process for Waivers for State Innovation - Opens in a new window
• February 22, 2012
  CMS-9987-F: Application, Review, and Reporting Process for Waivers for State Innovation - Opens in a new window

Consumer Operated and Oriented Plans Program

Regulations

• June 23, 2010
  Establishment of the Consumer Operated and Oriented Plan (CO-OP) Advisory Board - Opens in a new window
• July 20, 2011
  Establishment of the Consumer Operated and Oriented Plan (CO-OP) Program - Opens in a new window
• December 13, 2011
  CMS-9983-F: Patient Protection and Affordable Care Act, Establishment of Consumer Operated and Oriented Plan (CO-OP) Program - Opens in a new window (PDF - 244 KB)
• February 10, 2012
  IRS Revenue Procedures Published in the Federal Register For Tax-Exempt 501(c)(29) Qualified Nonprofit Health Insurance Issuers
• April 4, 2013
  Questions and Answers on Consumer Operated and Oriented Plan Program Contingency Fund (PDF - 168 KB) 

Health Market Reforms

Regulations

• November 26, 2012
  CMS-9979-P: Incentives for Wellness Programs in Group Health Plans - Opens in a new window
• November 26, 2012
  CMS-9972-P:Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review - Opens in a new window
• January 30, 2013
  CMS-9958-P: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions - Opens in a new window
• February 27, 2013
  CMS-9972-F:Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review - Opens in a new window

Guidance

• January 25, 2013
  Employer Prescription Drug Coverage that Supplements Medicare Part D Coverage provided through an Employer Group Waiver Plan(PDF - 216 KB)
• February 25, 2013
  Guidance Regarding Age Curves, Geographical Rating Areas and State Reporting (PDF - 175 KB)
  State Rating Requirements Disclosure Form (DOC - 33 KB)
• May 6, 2013
  Model Language for Individual Market Renewal Notices (PDF - 56 KB)

Annual Limits

Regulations

• June 28, 2010
  OCIIO–9994–IFC: Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections - Opens in a new window

Guidance

• September 3, 2010
  OCIIO Sub-Regulatory Guidance: Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711(PDF – 48 KB)
• November 5, 2010
  OCIIO Supplemental Guidance: Waivers of the Annual Limits Requirements (PDF – 61 KB)
• December 9, 2010
  OCIIO Supplemental Guidance:  Consumer Notices on Waivers of the Annual Limits Requirements (PDF – 53 KB)
• December 9, 2010
  OCIIO Supplemental Guidance: Sale of New Business by Issuers Receiving Waivers (PDF-55 KB)
• June 17, 2011
  CCIIO Supplemental Guidance (CCIIO 2011 – 1D): Concluding the Annual Limit Waiver Application Process (PDF – 76 KB)
• August 19, 2011
  CCIIO Supplemental Guidance (CCIIO 2011 - 1E): Exemption for Health Reimbursement Arrangements that are Subject to PHS Act Section 2711 (PDF - 44 KB)

Association Coverage

Guidance

• September 1, 2011
  CCIIO Technical Guidance: Application of Individual and Group Market Requirements under Title XXVII of the Public Health Service Act when Insurance Coverage Is Sold to, or through, Associations (PDF – 56 KB)

Coverage for Young Adults

Regulations

• May 13, 2010
  OCIIO – 4150 – IFC: Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of Children to Age 26 Under the Patient Protection and Affordable Care Act - Opens in a new window (PDF – 178 KB)

Guidance

• October 13, 2010
  Q&A: Enrollment of Children Under 19 Under the New Policy That Prohibits Pre-Existing Condition Exclusions

Employer Responsibility

Guidance

• October 13, 2010
  Frequently Asked Questions from Employers Regarding Automatic Enrollment, Employer Shared Responsibility, and Waiting Periods (PDF - 93 KB)
• August 31, 2012
  Waiting Period Guidance Under Public Health Service Act Section 2708 (PDF – 87 KB)
• March 21, 2013
  CMS-9952-P: Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act - Opens in a new window

Grandfathered Plans

Regulations

• June 17, 2010
  OCIIO–9991–IFC: OCIIO–9991–IFC: Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act - Opens in a new window (PDF – 258)
• November 15, 2010
  OCIIO–9991–IFC2: OCIIO–9991–IFC2: Amendment to the Interim Final Rules for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan Under the Patient Protection and Affordable Care Act - Opens in a new window

Medical Loss Ratio

Regulations

• December 1, 2010
  OCIIO–9998–IFC: Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements Under the Patient Protection and Affordable Care Act - Opens in a new window (PDF – 2 MB)
• Technical Appendix
  Interim Final Rule for Health Insurance Issuers Implementing Medical Loss Ratio (MLR) Requirements under the Patient Protection and Affordable Care Act (PDF – 300 KB)
• Technical Correction (December 30, 2010)
  Technical Correction to the Medical Loss Ratio Interim Final Rule - Opens in a new window (PDF – 59 KB)
• December 7, 2011
  CMS-9998-FC: Medical Loss Ratio Requirements under the Patient Protection and Affordable Care Act - Opens in a new window
  CMS-9998-IFC2: Medical Loss Ratio Rebate Requirements for Non-Federal Governmental Plans - Opens in a new window
• May 16, 2012
  CMS-9998-F: Medical Loss Ratio Requirements under the Patient Protection and Affordable Care Act - Opens in a new window
• May 16, 2012
  CMS-9998-IFC3: Medical Loss Ratio Requirements under the Patient Protection and Affordable Care Act; Correcting Amendment - Opens in a new window
• November 30, 2012
  CMS-9964-P: HHS Benefit and Payment Parameters for 2014, and Medical Loss Ratio - Opens in a new window
• March 11, 2013
  CMS-9964-F: HHS Benefit and Payment Parameters for 2014 - Opens in a new window

Guidance

• December 17, 2010
  OCIIO Technical Guidance: Process for a State to Submit a Request for Adjustment to the Medical Loss Ratio Standard of PHS Act Section 2718 (PDF – 35 KB)
• April 26, 2011
  CCIIO Technical Guidance: Submission of 2011 Quarterly Reports of MLR Data by Issuers of “Mini-med” and Expatriate Plans (PDF – 26 KB)
• May 13, 2011
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF – 75 KB)
• May 19, 2011
  CCIIO Technical Guidance: Deadline for Submission of 2011 First Quarter MLR Data by Issuers of “Mini-med” and Expatriate Plans (PDF – 26 KB)
• July 18, 2011
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF – 66 KB)
• February 10, 2012
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Interim Final Rule (PDF - 94 KB)
• March 30, 2012
  Memo to Insurance Companies: Medical Loss Ratio Annual Reporting Procedures (PDF - 96 KB)
• April 20, 2012
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Regulation (PDF –101 KB)
• May 15, 2012
  Memo to Insurance Companies: Guidance for Medical Loss Ratio Annual Reporting Form (PDF – 66 KB)
  Memo to Insurance Companies: Guidance for Medical Loss Ratio Notices of Rebates (PDF – 67 KB)
• May 24, 2012
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting Form (PDF - 91 KB)
• May 30, 2012
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting Requirements (PDF - 83 KB)
• July 17, 2012
  CCIIO Technical Guidance: Questions and Answers Regarding the Medical Loss Ratio Reporting and Rebate Requirements (PDF - 69 KB)
• March 29, 2013
  Memo to Insurance Companies: Guidance for 2012 Medical Loss Ratio Annual Reporting Form (PDF - 119 KB)
  Memo to Insurance Companies: Announcement Regarding Training for 2012 Medical Loss Ratio Reporting Period (PDF - 125 KB)
• April 5, 2013
  CCIIO Technical Guidance: Questions and Answers Regarding the MLR Reporting and Rebate Requirements (PDF - 139 KB)

Patient's Bill of Rights

Regulations

• June 28, 2010
  OCIIO–9994–IFC: Patient Protection and Affordable Care Act: Preexisting Condition Exclusions, Lifetime and Annual Limits, Rescissions, and Patient Protections - Opens in a new window

Guidance

• September 3, 2010
  OCIIO Sub-Regulatory Guidance: Process for Obtaining Waivers of the Annual Limits Requirements of PHS Act Section 2711

Prevention

Regulations

• July 19, 2010
  OCIIO–9992–IFC: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act
• August 3, 2011
  CMS-9992-IFC2: Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act - Opens in a new window (PDF - 201 KB)
• February 10, 2012
  CMS-9992-F: Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act - Opens in a new window (PDF – 164 KB)
• March 21, 2012
  CMS 9968-ANPRM: Preventive Services Under the Affordable Care Act - Opens in a new window (PDF - 263 KB)
• February 6, 2013
  CMS-9968-P: Coverage of Certain Preventive Services Under the Affordable Care Act - Opens in a new window

Guidance

• July 19, 2010
  Recommendation: Recommendations of the U.S. Preventive Service Task Force - Opens in a new window
• August 1, 2011
  Guidelines: HRSA's Women's Preventive Services: Required Health Plan Coverage Guidelines - Opens in a new window
• February 10, 2012
  CCIIO Technical Guidance: Guidance on the Temporary Enforcement Safe Harbor for Certain Employers, Group Health Plans and Group Health Insurance Issuers with Respect to the Requirement to Cover Contraceptive Services Without Cost Sharing Under Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act, and Section 9815(a)(1) of the Internal Revenue Code (PDF - 59 KB)
• August 15, 2012
  UPDATED CCIIO Technical Guidance: Guidance on the Temporary Enforcement Safe Harbor for Certain Employers, Group Health Plans and Group Health Insurance Issuers with Respect to the Requirement to Cover Contraceptive Services Without Cost Sharing Under Section 2713 of the Public Health Service Act, Section 715(a)(1) of the Employee Retirement Income Security Act, and Section 9815(a)(1) of the Internal Revenue Code (PDF - 49 KB)

Review of Insurance Rates

Regulations

• December 23, 2010
  OCIIO–9998–IFC: Rate Increase Disclosure and Review; Proposed Rule - Opens in a new window (PDF – 215 KB)
• May 19, 2011
  CMS-9999-FC: Rate Increase Disclosure and Review; Final Rule (PDF - 282 KB)
• September 6, 2011
  CMS-9999-F: Rate Increase Disclosure and Review: Definitions of Individual Market and Small Group Market - Opens in a new window (PDF - 526 KB)
• November 26, 2012
  CMS-9972-P:Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review - Opens in a new window
• February 22, 2013
  CMS-9972-F:Patient Protection and Affordable Care Act: Health Insurance Market Rules; Rate Review - Opens in a new window

Guidance

• March 30, 2012
  State-Specific Threshold Proposals Guidance for States (PDF - 200 KB)

Student Health Plans

Regulations

• February 11, 2011
  CMS–9981–P: Student Health Insurance Coverage - Opens in a new window (PDF – 250 KB)
• March 21, 2012
  CMS-9981-F: Student Health Insurance Coverage - Opens in a new window (PDF – 288 KB)

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Guidance

• March 1998
  Program Memorandum:Agent Commissions and Application and Process Delays (PDF - 87 KB)
• June 1999
  Program Memorandum: Applicability of the Health Insurance Portability and Accountability Act of 1996 to Secondary Coverage and Continuing Coverage(PDF - 157 KB)
• June 1999
  Program Memorandum: Issues Related to Eligible Individual Status Under the Health Insurance Portability and Accountability Act of 1996(PDF 130 KB)
• September 1999
  Program Memorandum: Group Size Issues Under Title XXVII of the Public Health Service Act (PDF - 136 KB)
• March 2000
  Program Memorandum: Imposing Nonconfinement Clause on Eligible Individuals(PDF -68 KB)
• June 2000
  Program Memorandum: Issue Related to Eligible Individual Status Under Section 2741(b) of the Public Health Service Act (PDF - 122 KB)
• June 2000
  Program Memorandum: The Relationship of Certain Types of State Laws to the Application of the Guaranteed Availability Requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) in the Small Group Market
• August 2000
  Program Memorandum: State “succeeding carrier” or “extension of benefits” laws and an issuer’s obligation under HIPAA to enroll an eligible individual who is disabled.
• November 2000
  Program Memorandum: Guaranteed Availability Under Title XXVII of the Public Health Service Act – Applicability of Group Participation Rules
• November 2000
  Program Memorandum: Circumstances Under which Health Insurance Regulated as “Individual” Coverage Under State Law is Subject to the Group Market Requirements of The Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• March 2001
  Program Memorandum: Guaranteed Renewability of Conversion Policies
• August 2001
  Program Memorandum: Identifying Federally Eligible Individuals in states Electing to Use Alternative mechanisms to Comply with Guaranteed Availability Requirements under Title XXVII of the PHS Act
• March 2002
  Program Memorandum: How to Apply the “Product Withdrawal” and “Market Exit” Exceptions of the Guaranteed Renewability Requirements of Title XXVII of the PHS Act
• August 2002
  Program Memorandum: Application of Group and Individual Market Requirements Under Title XXVII of the Public Health Service (PHS) Act When Insurance Coverage is Sold To, or Through Associations
• August 2002
  Program Memorandum: The Obligation Health Insurance Issuers Have to Association Members and Associations Under Title XXVII of the PHS Act With Respect to Guaranteed Renewability of Coverage
• September 2002
  Program Memorandum: Characteristics of Bona Fide Associations, and How Selling Coverage Exclusively Through Them Affects an Issuer’s Guaranteed Availability Obligations Under Title XXVII of the PHS Act
• September 2002
  Program Memorandum: How Selling Coverage Exclusively Through Bona Fide Associations Affects and Issuer’s Guaranteed Renewability Obligations Under Title XXVII of the PHS Act
• March 2004
  Program Memorandum: HIPAA Enforcement Is Not Preempted by COBRA; Non-HIPAA-Related State Insurance Law is Not Preempted by Public Sector COBRA
• June 2004
  Program Memorandum: Federal Eligibility Under HIPAA After Group Health Plan Termination
• March 2005
  Program Memorandum: Coverage through a Foreign Government, the U.S. Government, and a State Children’s Health Insurance Program, is Creditable Coverage for Purposes of Identifying Eligible Individuals under HIPAA
• June 2005
  Program Memorandum: Benefit Exclusions that Cannot be Applied to Eligible Individuals Under HIPAA Individual Market Provisions
• May 2008
  Program Memorandum: Circumstances Under Which Supplemental Health Insurance Coverage Satisfies the Requirements for Excepted Benefits Under Section 2791(c) of the Public Health Service Act