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On December 20, the Department of Health and Human Services (“HHS”) issued a final rule that aims to strengthen oversight of state-based exchanges and ensure accurate eligibility determinations for premium subsidies. Specifically, the final rule:

  • Increases federal oversight of state-based exchanges that operate their own eligibility and enrollment platforms to ensure that they are accurately determining eligibility for premium subsidies;
  • Requires all exchanges to conduct periodic data matching twice a year to (1) resolve issues related to consumers who are dually enrolled in Medicare and a plan through the exchange, and (2) check to see if consumers have become eligible for/enrolled in coverage that renders them ineligible for premium subsidies; and
  • Establishes a “separate billing” requirement for abortion services (i.e., requires insurers to send a separate bill to consumers for the portion of their premium attributable to coverage of certain abortion services for which public funding is prohibited and to instruct consumers to separately pay for that portion of their premium).

Due to the abortion-related provision, state attorneys general, reproductive rights groups, and others are expected to challenge the new rule in court. More information on the final rule is available here.