Health Reform + Related Health Policy News Update: January 30, 2013

In This Issue:

- Top News

..CMS, IRS Issue Proposed Rules on Health Insurance Mandate, Minimum

- Essential Coverage

..Insurers Weigh Options for Exchange Participation

..Quality Improvements in Care Transitions Show a Significant Reduction in


..Pew Charitable Trust Proposes Compounding Quality Standards

- State News

..Providers File Appeal to Block Medi-Cal Cuts

..Kaiser Survey Finds States Upgrading Medicaid Enrollment Systems

- Regulatory News

..CMS Updating Manuals, Plans Education Campaign, on Improvement Standard Settlement

..HHS, Treasury, and Labor Department Posts FAQs Regarding ACA Implementation

..HHS Offers Guidelines for HIPAA Compliance

- Additional Reading

- Federal Register

- For More Information

- Excerpt from CMS, IRS Issue Proposed Rules on Health Insurance Mandate, Minimum Essential


CMS and the IRS on January 30 issued proposed rules that address the Affordable Care Act’s (ACA) minimum essential coverage requirement. Beginning in 2014, the ACA requires that each individual have basic health insurance, qualify for an exemption, or pay a penalty when filing a federal income tax return. This “shared responsibility payment” does not apply to taxpayers who cannot afford health insurance coverage or have a “good cause” for being uninsured for a short time. To implement this principal, the rule enumerates several situations in which an exemption would apply. For example, the penalty would not apply to who would be eligible for Medicaid but for a state’s decision not to expand eligibility. The proposed rule includes nine categories of individuals who are exempt from the penalty: individuals who cannot afford coverage; taxpayers with income below the filing threshold; members of Indian tribes; hardship; individuals who experience short coverage gaps; religious conscience; members of a health care sharing ministry; incarcerated individuals; and individuals who are not lawfully present.

Please see full update below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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