Reinsurance (RP) FAQ
Guidance for FAQ regarding Other and Other
Program Area: Reinsurance (RP)
Question: Will HHS use the edge server to collect claims and reimburse issuers for contraceptive benefits paid on behalf of group health plans established or maintained by eligible organizations under the accommodation established in 45 CFR 147.131?
Answer: We have not yet specified the manner in which the data will be submitted, and will provide that information in future guidance. The final rule "Coverage of Certain Preventive Services Under the Affordable Care Act" published by the Departments of Health and Human Services (HHS), Treasury, and Labor on July 2, 2013, set forth requirements regarding coverage for certain preventive services under section 2713 of the Public Health Service Act. Section 2713 of the Public Health Service Act requires coverage without cost sharing of certain preventive health services, including certain contraceptive services, by non-exempt, non-grandfathered group health plans and health insurance coverage. This final rule provides an accommodation for group health plans established or maintained by eligible organizations. The final rules provide that a group health insurance issuer that would otherwise provide contraceptive coverage for these group health plans must exclude the coverage from the group health insurance coverage, and provide separate payments for the contraceptive services. The final rules also establish processes and standards to fund the payments for the contraceptive services that are provided for participants and beneficiaries in self-insured plans of eligible organizations under this accommodation, through an adjustment in the Federally-facilitated Exchange (FFE) user fee payable by an issuer participating in an FFE. In order to facilitate the FFE user fee adjustment, and ensure that these user fee adjustments reflect payments for contraceptive services provided under this accommodation and that the adjustment is applied to the appropriate participating issuer in an FFE, the final rule requires certain information be collected from applicable participating issuers and third party administrators. Please refer to the "Coverage of Certain Preventive Services under the Affordable Care Act" final rule for further information on these submission standards (See http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf).
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: December 13, 2013
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