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Pre-Regulatory Model Guidelines Under Section 1303 of the Affordable Care Act

September 20, 2010

Executive Order 13535, “Ensuring Enforcement and Implementation of Abortion Restrictions in the Patient Protection and Affordable Care Act” (March 24, 2010), directs the Office of Management and Budget and the Department of Health and Human Services to develop “a model set of segregation guidelines for State health insurance commissioners to use when determining whether exchange plans are complying with the [Affordable Care] Act’s segregation requirements, established in § 1303 of the Act, for enrollees receiving Federal financial assistance.”  The attached pre-regulatory model guidelines are issued pursuant to the Executive Order’s directive. 

The Executive Order directs HHS to “initiate a rulemaking to issue interpret the Act’s segregation requirements, and [to]...provide guidance to State health insurance commissioners on how to comply with the model guidelines.”  HHS expects that it will promulgate a Notice of Proposed Rulemaking (NPRM) that, after a public comment period, will result in a Final Rule that will take effect concurrently with the establishment and operation of the Exchanges in 2014.  The attached model guidelines are thus pre-regulatory and will be finalized with the issuance of a final rule before 2014.  OMB and HHS anticipate that both public input from the accounting community, insurance industry, and interested parties during the rulemaking period, along with details about the operational and business features of the Exchanges as they are developed, will inform clarifications and enhancements to the guidelines.

As directed by the Executive Order, in developing these pre-regulatory model guidelines, HHS and OMB consulted with “executive agencies and offices that have relevant expertise in accounting principles, including...the Department of the Treasury, and...the Government Accountability Office.” 


Daniel I. Werfel
Office of Management and Budget
Ellen Murray
Assistant Secretary for Financial Resources
Department of Health and Human Services


Attachment - Pre-Regulatory Model Guidelines Under Section 1303 of the Affordable Care Act