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HHS/CMS RIN: 0938-AS02 Publication ID: Spring 2014 
Title: Exchange and Insurance Market Standards for 2015 and 2016 (CMS-9949-P) 
Abstract: This final rule addresses various requirements applicable to health insurance issuers, Affordable Insurance Exchanges ("Exchanges"), Navigators, non-Navigator assistance personnel, and other entities under the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). Specifically, the rule establishes standards related to product discontinuation and renewal, quality reporting, non-discrimination standards, minimum certification standards and responsibilities of qualified health plan (QHP) issuers, the Small Business Health Options Program, and enforcement remedies in Federally-facilitated Exchanges. It also finalizes: certain changes to the ceiling on allowable administrative expenses in the risk corridors calculation; modifications to the way we calculate the annual limit on cost sharing so that we round this parameter down to the nearest $50 increment; an approach to index the required contribution used to determine eligibility for an exemption from the shared responsibility payment under section 5000A of the Internal Revenue Code; grounds for imposing civil money penalties on persons who provide false or fraudulent information to the Exchange and on persons who improperly use or disclose information; updated standards for the consumer assistance programs; standards related to the opt-out provisions for self-funded, non-Federal governmental plans and related to the individual market provisions under the Health Insurance Portability and Accountability Act of 1996; standards for recognition of certain types of foreign group health coverage as minimum essential coverage; amendments to standards regarding how enrollees may access non-formulary drugs if medically necessary; amendments to Exchange appeals standards and coverage enrollment and termination standards; and time-limited adjustments to the standards relating to the medical loss ratio program. 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 45 CFR 144    45 CFR 146    45 CFR 147    45 CFR 148    45 CFR 153    45 CFR 155    45 CFR 156    45 CFR 158   
Legal Authority: PL 11-148 secs 1301 to 1304    secs 1311 to 1313    secs 1321 and 1322    secs 1331 and 1332    secs 1334 and 1402   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  03/21/2014  79 FR 15807   
NPRM Comment Period End  04/21/2014 
Final Rule  05/27/2014  79 FR 30240   
Final Action Effective  07/28/2014 
Regulatory Flexibility Analysis Required: No  Government Levels Affected: Federal, State 
Small Entities Affected: Businesses, Governmental Jurisdictions  Federalism: Yes 
Included in the Regulatory Plan: Yes 
RIN Data Printed in the FR: No 
Agency Contact:
Jacob Ackerman
Health Insurance Specialist
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Center for Consumer Information and Insurance Oversight, MS: 733H.02, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:301 492-4179
Email: jacob.ackerman@cms.hhs.gov