Healthcare reform roundup: Individual mandate proposed rule and missed deadlines

There has been a lot of activity around the Affordable Care Act (ACA) in the last few days. The Obama Administration released a proposed rule detailing the controversial individual mandate, while at the same time Kaiser Health News posted an article claiming the administration has missed other important deadlines. Individual mandate proposed rule Earlier this week, The Department of Health and Human Services and the Internal Revenue Service both issued proposed rules that outline the individual mandate portion of the ACA, which requires nonexempt individuals to maintain minimum essential coverage or be subject to an additional payment with their federal income tax return. Under the proposed rule, millions of Americans would be exempt from the mandate, including taxpayers with incomes below the filing threshold, those who can’t afford coverage, members of Indian tribes, people who qualify for hardship exemptions, individuals who have short coverage gaps, those who object to health insurance for religious reasons, members of “health sharing ministries,” and individuals who are incarcerated. The rule clarifies situations that would qualify someone for a hardship exemption.

• Individuals whom an Exchange projects will have no offer of affordable coverage (even if, due to a change in circumstance during the year, it turns out that the coverage would have been affordable).
• Certain individuals who are not required to file an income tax return but who technically fall outside the statutory exemption for those with household income below the filing threshold
• Individuals who would be eligible for Medicaid, but their state decided not to expand Medicaid eligibility.

Furthermore, individuals who have coverage for one day in a month are considered to be covered for that month. Individuals who are without coverage for less than three months in any year are not subject to the annual penalty. Missed deadlines The proposed rule is a step towards ensuring the administration meets the deadline for implementing the individual mandate provision, which goes into effect January 1, 2014. However, initiatives that were supposed to take effect January 1, 2012 have not, including an increase in Medicaid payments to primary care physicians. The payment increases are designed to make Medicaid payments on par with Medicare and encourage physicians, nurse practitioners, and other primary care providers to accept Medicaid patients. State officials said the rule, which was issued in November, didn’t give them enough time to implement the changes. The Centers for Medicare and Medicaid Services (CMS) told doctors they will get the higher fees retroactively to January 1, once the states implement the provision. The federal government was also supposed to increase Medicaid matching payments to states that eliminated requirements for co-pays for immunizations and other preventive services at the start of 2013. So far, the administration has not issued a rule outlining the program. It’s perhaps no surprise that the administration is missing deadlines, having just gone through a reelection campaign and experiencing turnover in certain key positions. Perhaps we will see more rules come out in the coming months as they try to make up for lost time.