Medicaid program; eligibility changes under the Affordable Care Act of 2010. Final rule, Interim final rule

This final rule implements several provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act). The Affordable Care Act expands access to health insurance coverage through improvements to the Medicaid and Children's Health Insurance (CHIP) programs, the establishment of Affordable Insurance Exchanges ("Exchanges"), and the assurance of coordination between Medicaid, CHIP, and Exchanges. This final rule codifies policy and procedural changes to the Medicaid and CHIP programs related to eligibility, enrollment, renewals, public availability of program information and coordination across insurance affordability programs.     

Patient protection and Affordable Care Act; data collection to support standards related to essential health benefits; recognition of entities for the accreditation of qualified health plans. Final rule

This final rule establishes data collection standards necessary to implement aspects of section 1302 of the Patient Protection and Affordable Care Act (Affordable Care Act), which directs the Secretary of Health and Human Services to define essential health benefits. This final rule outlines the data on applicable plans to be collected from certain issuers to support the definition of essential health benefits. This final rule also establishes a process for the recognition of accrediting entities for purposes of certification of qualified health plans.     

Patient Protection and Affordable Care Act; standards related to reinsurance, risk corridors, and risk adjustment. Final rule

This final rule implements standards for States related to reinsurance and risk adjustment, and for health insurance issuers related to reinsurance, risk corridors, and risk adjustment 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. These programs will mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the Affordable Insurance Exchanges ("Exchanges") are implemented, starting in 2014. The transitional State-based reinsurance program serves to reduce uncertainty by sharing risk in the individual market through making payments for high claims costs for enrollees. The temporary Federally administered risk corridors program serves to protect against uncertainty in rate setting by qualified health plans sharing risk in losses and gains with the Federal government. The permanent State-based risk adjustment program provides payments to health insurance issuers that disproportionately attract high-risk populations (such as individuals with chronic conditions).     

Medical loss ratio requirements under the Patient Protection and Affordable Care Act. Final rule

This final rule amends the regulations implementing medical loss ratio (MLR) standards for health insurance issuers under the Public Health Service Act in order to establish notice requirements for issuers in the group and individual markets that meet or exceed the applicable MLR standard in the 2011 MLR reporting year.     

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Interim final rules with request for comments

This document contains amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding preventive health services.     

Medical loss ratio requirements under the Patient Protection and Affordable Care Act. Final rule with comment period

This final rule with comment period revises the regulations implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act in order to address the treatment of "mini-med" and expatriate policies under these regulations for years after 2011; modify the way the regulations treat ICD-10 conversion costs; change the rules on deducting community benefit expenditures; and revise the rules governing the distribution of rebates by issuers in group markets.     

Group health plans and health insurance issuers relating to coverage of preventive services under the Patient Protection and Affordable Care Act. Final rules

These regulations finalize, without change, interim final regulations authorizing the exemption of group health plans and group health insurance coverage sponsored by certain religious employers from having to cover certain preventive health services under provisions of the Patient Protection and Affordable Care Act.     

Health insurance issuers implementing medical loss ratio (MLR) requirements under the Patient Protection and Affordable Care Act. Interim final rule with request for comments

This document contains the interim final regulation implementing medical loss ratio (MLR) requirements for health insurance issuers under the Public Health Service Act, as added by the Patient Protection and Affordable Care Act (Affordable Care Act).     

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. Amendment to interim final rules with request for comments

This document contains an amendment to interim final regulations implementing the rules for group health plans and health insurance coverage in the group and individual markets under provisions of the Patient Protection and Affordable Care Act regarding status as a grandfathered health plan; the amendment permits certain changes in policies, certificates, or contracts of insurance without loss of grandfathered status.     

美国《医改法案》中的宪法决断

美国医疗体制积弊丛生,奥巴马政府为进行医改,推动国会通过了《医改法案》。然而,《医改法案》在全美引发了"医改违宪"的诉讼大战,最终该争议被提交到联邦最高法院。以罗伯茨为首席大法官的最高法院,判决认定《医改法案》的关键部分——"个人强制"条款因合乎宪法赋予国会的征税权而合宪;而"医疗补助扩大计划"因为违反了联邦主义原则而违宪。这既支持了奥巴马政府致力于医改的努力,也厘清了美国宪法中立法权和行政权的边界。该判决不仅事关美国普通民众的福祉,而且直接影响2012年11月的总统大选,并将对美国社会产生深远的影响,也会因此而成为美国宪法史上的经典一例。     

Interim status standards for owners and operators of hazardous waste treatment, storage, and disposal facilities--Environmental Protection Agency. Interim final rule and interim final amendments to rules and request for comments

The Environmental Protection Agency [EPA] has issued standards applicable to owners and operators of hazardous waste management facilities as required by the Resource Conservation and Recovery Act [RCRA]. One of these standards bans the disposal of most containerized liquid hazardous waste in landfills, effective November 19, 1981. As a result of reconsideration of this restriction, EPA is today promulgating an interim final rule to allow the disposal of small containers of liquid and solid hazardous waste in landfills provided that the wastes are placed in overpacked drums [lab packs] in the manner specified in today's rule. The purpose of today's rule is to provide an environmental sound disposal option for generators of small containers of hazardous wastes, such as laboratories.     

Medicare program; waiver requirements and solvency standards for provider-sponsored organizations--HCFA. Interim final rule with comment period

This interim final rule with a request for comments implements authority to waive, in the case of provider-sponsored organizations (PSOs) that meet certain criteria, the requirement that Medicare + Choice organizations be licensed by a State as risk-bearing entities. The waivers will be approved only under certain conditions where the State has denied or failed to act on an application for licensure. This rule also establishes solvency standards that certain entities must meet to contract as PSOs under the new Medicare + Choice program. These standards apply to PSOs that have received a waiver of the requirement that Medicare + Choice organizations be licensed by a State as risk-bearing entities.     

美国《病人保护和可负担医疗法》的主要内容及启示

美国《病人保护和可负担医疗法》围绕扩大保险覆盖面、强化公共项目、提升医疗质量和效率、提高项目透明和廉正度、加强医疗服务人力资源建设和合理化资金投入等对美国医疗体系进行了全面而深入的变革。美国＂低成本、全覆盖＂的医疗改革可以为中国提供有益借鉴。     

Age Discrimination in Employment Act; retiree health benefits. Final rule

The Equal Employment Opportunity Commission is publishing this final rule so that employers may create, adopt, and maintain a wide range of retiree health plan designs, such as Medicare bridge plans and Medicare wrap-around plans, without violating the Age Discrimination in Employment Act of 1967 (ADEA). To address concerns that the ADEA may be construed to create an incentive for employers to eliminate or reduce retiree health benefits, EEOC is creating a narrow exemption from the prohibitions of the ADEA for the practice of coordinating employer-sponsored retiree health benefits with eligibility for Medicare or a comparable State health benefits program. The rule does not otherwise affect an employer's ability to offer health or other employment benefits to retirees, consistent with the law.