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CCIIO Releases Final Rule for Small Business Health Options Program

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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

CCIIO Releases Final Rule for Small Business Health Options Program

June 7, 2013 | Uncategorized | Comments
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This week, the Centers for Medicare and Medicaid Services’ Center for Consumer Information and Insurance Oversight (CCIIO) released a final rule on the Small Business Health Options Program (SHOP) and, in tandem, finalized SHOP applications for small employers (3 pages) and their employees (2 pages) to use starting on October 1, 2013, in SHOP Marketplaces.

In the final rule, CCIIO implements the proposed transition “so that SHOPs provide qualified employers the option to offer qualified employees a choice of any QHP at a single metal level starting with plan years beginning on or after January 1, 2015, instead of January 1, 2014,” the rule says, with the following parameters:

  • 2014 –Federally-facilitated SHOPs will allow qualified employers to offer qualified employees coverage through a single QHP. State-based SHOPs have the option of offering either the employer choice model or employee choice under which employers can let their employees choose from a number of plans.
  • 2015 and forward – All SHOPs will allow small businesses to let their employees choose coverage from a number of plans.

In the preamble, CCIIO says that even in SHOPs that elect to transition to employee choice models, “there is still significant value to the SHOP for small employers” compared with the outside-of-SHOP small group market, such as gaining “assistance modeling employee contributions” and seeing a “streamlined comparison of health plans” meeting QHP certification criteria.

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