The OIG produces its list of Top Management and Performance Challenges (TMC) every year, and to no one's surprise, implementation of health reform tops the list this year.  The rest of the list includes a collection of fraud and abuse, quality of care and consumer protection priorities, plus a couple of interesting issues, such as protecting integrity and security of health IT systems and data and fostering an ethical and transparent environment.

ACA implementation efforts have come out from under wraps post-Election Day, and last week, HHS issued proposed rules on a number of health insurance issues (pre-existing condition nondiscrimination, essential health benefits and employment-based wellness programs) that must be in place before January 1, 2014.

A little more detail from the HHS presser; these rules include:

  • A proposed rule that, beginning in 2014, prohibits health insurance companies from discriminating against individuals because of a pre-existing or chronic condition.  Under the rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.  Health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry. The rule would ensure that people for whom coverage would otherwise be unaffordable, and young adults, have access to a catastrophic coverage plan in the individual market.  For more information regarding this rule, visit: /www.healthcare.gov/news/factsheets/2012/11/market-reforms11202012a.html.
  • A proposed rule outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act. Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.  For more information regarding this rule, visit /www.healthcare.gov/news/factsheets/2012/11/ehb11202012a.html.
  • A proposed rule implementing and expanding employment-based wellness programs to promote health and help control health care spending, while ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.  For more information regarding this rule, visit: /www.healthcare.gov/news/factsheets/2012/11/wellness11202012a.html

David Harlow
The Harlow Group LLC
Health Care Law and Consulting