AMA Comments on ACA Implementation Regulations
As implementation of Affordable Care Act (ACA) provisions proceeds, the AMA is rapidly responding to regulatory proposals being issued by various federal agencies. Following is a summary of key regulations and opportunities for public comment that have been issued so far, with links to relevant federal documents and comments submitted by the AMA.
Meaningful administrative simplification would result in significant savings and benefits to physicians and the health care delivery and payment system.
Request for comments - April 17, 2012
Request for comments - January 10, 2012
AMA comments
May 17, 2012 comment letter to CMS
Legal barriers need to be removed in order for physicians to participate in the models of patient care, such as Accountable Care Organizations (ACOs), which will be tested under the new health care law.
Request for Comments - April 7, 2011
Request for Comments - April 19, 2011
Request for Comments - November 17, 2010
Request for Comments - September 17, 2010
AMA Comments
June 3, 2011 AMA comment letter to CMS Administrator Berwick
May 26, 2011 AMA comment letter to FTC Secretary Donald Clark
December 2, 2010 AMA letter to CMS Administrator Donald Berwick, MD
The ACA offers states the option of implementing the Basic Health Program (BHP), which provides states 95 percent of what the federal government would have spent on tax credits and subsidies for out-of-pocket costs for adults with incomes between 133 and 200 percent of the federal poverty level (FPL), and for legally resident immigrants with incomes below 133 percent FPL who do not qualify for Medicaid. Individuals eligible for the BHP cannot receive subsidized coverage in the state exchange.
Request for comments - September 14, 2011
AMA Comments
October 31, 2011 comment letter
Consumers are given the right to appeal health plan decisions.
Amendment to July 2010 Interim Final Rule - June 24, 2011
Interim Final Rule - July 23, 2010
AMA Comments
July 25, 2011 comment letter to DOL, HHS and IRS
Section 1322(a) of ACA requires the Secretary of Health and Human Services (HHS) to establish the Consumer Operated and Oriented Plan (CO-OP) program. Operating as nonprofit organizations, CO-OPs will compete directly with established nonprofit and profit-seeking insurers.
Request for comments - July 20, 2011
Request for comments - February 2, 2011
AMA comments
September 15, 2011 comment letter to HHS
Insurers are required to cover certain evidence-based preventive services at no cost to plan enrollees.
Interim Final Rule - July 19, 2010
AMA Comments
September 17, 2010 comment letter to HHS
Individual and new employer health plans are required to make dependent coverage available until a child reaches the age of 26.
Interim Final Rule May 13, 2010
AMA Comments
AMA did not comment
Effective in 2014, all qualified health benefits plans, including those offered in exchanges and in the individual and small group markets outside of exchanges, with the exception of grandfathered individual and employer-sponsored plans, will be required to offer at least the essential health benefits package.
Request for Comments, November 26, 2012
Request for Comments, December 16, 2011
Request for Comments, December 2010
AMA Comments
December 21, 2012, AMA Comments to CMS
Effective for payments made after December 31, 2011, section 9006 of the ACA (incorporated as section 6041 of the internal Revenue Code) requires all businesses that pay any amount greater than $600 during the year to corporate and non-corporate providers of property, goods and services to file an information report--Form 1099--with the IRS.
Request for Comments - July 19, 2010
AMA Comments
September 29, 2010 comment letter to IRS
Individuals and businesses may keep their current health plans during the transition to making coverage available through health insurance exchanges.
Interim Final Rule - June 17, 2010
AMA Comments
August 12, 2010 comment letter to HHS
Insurance marketplace competition will be enhanced starting in 2014, with coverage offered through state-based Health Insurance Exchanges.
Request for Information, April 22, 2013
Request for Comments, December 7, 2012
Request for comments, December 5, 2012
Request for Information, November 27, 2012
CMS Guidance Document on Federally-Facilitated Exchanges - May 16, 2012
IRS Request for Comments - September 6, 2011
Request for Comments - August 4, 2011
Request for Comments - July 15, 2011
OPM Request for Information - June 16, 2011
Request for Comments - August 3, 2010
AMA Comments
April 22, 2013 comment letter to CMS Acting Administrator Tavenner
January 4, 2013 comment letter to Office of Personnel Management
December 27, 2012 comment letter to CMS
December 21, 2012 comment letter to CMS
June 18, 2012 comment letter to CMS Acting Administrator Tavenner
October 31, 2011 comment letter to IRS Commissioner Shulman
October 31, 2011 comment letter to Secy. Berwick
October 24, 2011 comment letter to Secretary Sebelius
September 6, 2011 comment letter to OPM
October 4, 2010 comment letter to HHS
Sec. 2701 of ACA requires the Secretary of HHS to develop an initial core set of health quality measures recommended for Medicaid-eligible adults.
Request for comments - December 30, 2010
AMA Comments
February 24, 2011 comment letter to HHS
Sec. 3011 of ACA requires the HHS Secretary to establish and deliver a National Health Care Quality Strategy and Plan to Congress by January 1, 2011.
AMA Comments
October 15, 2010 comment letter to HHS
The ACA extends and simplifies Medicaid eligibility beginning in 2014 to cover all individuals under age 65 with incomes below 133 percent of the Federal Poverty Level; replaces the current standards and methods for evaluating income eligibility, and simplifies eligibility determination and enrollment and re-enrollment procedures.
Request for comments – January 22, 2013
Request for comments - August 17, 2011
AMA Comments
February 21, 2013 comment letter
Health insurers offering individual or group coverage will be required to submit annual reports on the percentages of premiums spent on health care and quality improvement, and to provide rebates to enrollees if this spending does not meet minimum standards.
Request for Comments - April 7, 2011
Request for Comments - December 1, 2010
Request for Comments - April 14, 2010
AMA Comments
June 3, 2011 AMA comment letter to CMS Administrator Berwick
February 28, 2011 supplemental comments to HHS
January 31, 2011 comment letter to HHS
June 20, 2010 comment letter to NAIC
June 7, 2010 comment letter to NAIC
Physicians and eligible professionals who order and refer covered items and services for Medicare beneficiaries are required to be enrolled in Medicare. Providers and suppliers participating in the Medicare program must also provide documentation on referrals to programs at high risk of waste and abuse.
Interim Final Rule - May 5, 2010
AMA Comments
March 30, 2011 comment letter to HHS
May 28, 2010 comment letter to HHS
May 6, 2010 comment letter to HHS
Section 2702 of ACA directs the Secretary of HHS to identify current state practices that prohibit payment for Health Care-Acquired Conditions (HCACs) and incorporate the practices identified, or elements of such practices, which the Secretary determines appropriate for application to the Medicaid program in regulations to be effective as of July 1, 2011.
Request for comments - February 17, 2011
AMA comments
March 18, 2011 comment letter to HHS
This proposed rule includes provisions to implement new limitations on certain physician referrals to hospitals in which they have an ownership or investment interest.
Interim Final Rule - August 3, 2010
AMA Comments
August 31, 2010 comment letter to HHS
Preexisting condition exclusions or denials, lifetime dollar limits on benefits, and rescissions are banned except in clear cases of fraud. Patients are also protected with respect to choice of health care professionals and no prior authorization requirements for emergency care, including services provided out-of-network.
Interim Final Rule - June 28, 2010
AMA Comments
August 27, 2010 comment letter to HHS
The Secretary of HHS is required to work with states to establish an annual review of unreasonable insurance rate increases, to monitor premium increases, and to award grants to states to carry out their rate review processes.
Request for Comments - December 23, 2010
Request for Comments - April 4, 2010
AMA Comments
February 22, 2011 comment letter to HHS
June 30, 2010 comment letter to NAIC
A number of critical factors must be considered as CMS develops an implementation plan for ACA transparency reporting:
- Section 6002 of ACA calls for Reporting of Physician Ownership or Investment Interests
- Section 10331 of ACA requires CMS to establish a Physician Compare website by January 1, 2011
- Section 10332 of ACA calls for the availability of Medicare Data for Performance Measurement
Request for Comments - December 19, 2011
Notice: October 27, 2010 Town Hall Meeting re: Physician Compare Web Site
Background Paper for September 20, 2010 Listening Session
Request for Comments - June 8, 2011
AMA Comments
October 10, 2012 AMA comments to CMS as follow-up to Senate Special Committee on Aging Roundtable
February 17, 2012 AMA sign-on comment letter to CMS
February 16, 2012 CME Provider sign-on comment letter to CMS
August 8, 2001 AMA sign on comment letter to CMS
April 8, 2011, AMA Comments to CMS
The ACA requires the creation of programs for risk adjustment, transitional reinsurance, and temporary risk corridors to mitigate the impact of potential adverse selection and stabilize premiums in the individual and small group markets as insurance reforms and the exchanges are implemented.
Request for comments - July 15, 2011
AMA Comments
October 31, 2011 comment letter
