Department of Health and Human Services: Patient Protection and Affordable Care Act; Health Insurance Market Rules; Rate Review
GAO-13-450R, Mar 13, 2013
GAO reviewed the Department of Health and Human Services (HHS) new rule on the Patient Protection and Affordable Care Act's health insurance market rules; and rate review. GAO found that (1) the final rule implements provisions related to fair health insurance premiums, guaranteed availability, guaranteed renewability, single risk pools, and catastrophic plans, consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. The final rule clarifies the approach used to enforce the applicable requirements of the Affordable Care Act with respect to health insurance issuers and group health plans that are nonfederal governmental plans. This final rule also amends the standards for health insurance issuers and states regarding reporting, utilization, and collection of data under the federal rate review program, and revises the timeline for states to propose state-specific thresholds for review and approval by the Centers for Medicare & Medicaid Services (CMS); and (2) HHS complied with the applicable requirements in promulgating the rule.