Affordable Care Act Resources for Health Carriers

TDI Resources | Federal Resources | Filing Time Frames

TDI Resources

• Bulletin on Department approach to form and rate review in anticipation of changes to federal law that became effective on January 1, 2014, and geographic rating areas for Texas under federal law
• Product Checklists for compliance with Texas requirements
• The Affordable Care Act Resource Page provides general information designed for a broad audience and includes details on the essential health benefits package in Texas
• Frequently Asked Questions (FAQs) - updated June 19, 2018
  

Federal Resources

• Federal regulations and guidance are organized by topic on the Center for Information and Insurance Oversight CCIIO resource page
• The NAIC has compiled a resource document that includes FAQs released by the U.S. Department of Health and Human Services and the U.S. Department of Labor

CMS Regulatory Role in Texas

CMS is responsible for the enforcement of the PPACA market reforms (Public Health Service Act (PHSA) sections 2723 and 2761) and for the review of rate increases above the reasonableness review threshold (PHSA section 2794).

In order to enforce the provisions above, CMS requires Texas carriers to submit form filings through HIOS for federal review; see CCIIO's March 24, 2017, letter to Texas issuers RE: Form and Rate Filing Instructions and Health Insurance Oversight System (HIOS) Technical Assistance for Plan Year 2018.

Geographic Rating Areas for Texas Issuers

Federal regulations established 26 geographic rating areas for Texas: one for each of the 25 Metropolitan Statistical Areas (MSAs) located in Texas, and one additional geographic rating area that applies to all areas of the state not part of an MSA; see federal guidance, "Texas geographic rating areas, including specific geographic divisions for the Individual and Small Group market."

Guidance for Qualified Health Plans (QHPs) Participating in the Federally Facilitated Marketplace

CMS' primary source of operational and technical guidance are the 2018 Letter to Issuers in the Federally-facilitated Marketplaces and the Addendum to 2018 Letter to Issuers in the Federally-facilitated Marketplaces and the HHS Notice of Benefit and Payment Parameters for 2018. Carriers may also access technical assistance via www.regtap.info, email the Help Desk at CMS_FEPS@cms.hhs.gov, or call 1-855-CMS-1515.

• HHS QHP application templates are available via SERFF
• Texas issuers must submit QHP applications to HIOS; see federal guidance, State Plan Management Systems
• Issuers may register for HIOS via portal.cms.gov/; technical support regarding HIOS registration is available through the HIOS Help Desk at 1-855-CMS-1515 or CMS_FEPS@cms.hhs.gov

Filing Time Frames

The table below illustrates the deadlines for filing rates and forms for plans sold in the individual or small group market that will be effective on or after January 1, 2018, including those that will be sold in the health insurance marketplace (exchange), with open enrollment beginning November 1, 2017.

Additional Considerations

1. Federal guidance indicates that the same rate and form filing deadlines apply to QHP and non-QHP rate and form filings. However, while a QHP must file forms each year, a non-QHP is not required to file forms with CMS unless changes were made to the forms that require the issuer to file with TDI.
2. Texas does not impose different filing requirements for QHPs; however, carriers may need to file simultaneously with TDI and HHS to meet QHP certification deadlines.
3. Federal guidance indicates that all carriers utilizing open enrollment periods may have to adhere to the full federal open enrollment periods. Thus, even issuers not seeking to sell on the exchange should consider whether they must offer guaranteed issue coverage beginning November 1, 2017, for 2018 effective dates or whether they will have to offer coverage all year round.