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Thursday, May 15, 2014

New Law Repeals the Affordable Care Act’s Annual Deductible Cap for Small Group Policies

Congress has passed, and the President has signed, the Protecting Access to Medicare Act of 2014 to postpone changes to the formula used to determine the amounts Medicare pays physicians for services. While the primary focus is Medicare, the legislation contains other provisions not directly related to Medicare, including elimination of the Affordable Care Act’s limitations on annual deductibles.

As background, starting in 2014, the ACA established maximum annual deductibles of $2,000 for a plan covering a single individual and $4,000 for any other plan (indexed for increases in health insurance costs). In the preamble to final regulations issued in February 2013, HHS had clarified that these limits would apply only to the small group insurance market—not to self-insured employer plans or to the large group insurance market. Elimination of the deductible limits is effective “as if included in the enactment” of health care reform, essentially treating the limits as though they had never been part of the law.

The legislation also makes a change to HIPAA’s electronic transaction standards; delaying adoption of ICD-10 medical data code sets (updated codes used to classify diseases and health problems) until at least October 1, 2015.  HHS regulations had previously delayed the ICD-10 compliance date from October 1, 2013 to October 1, 2014. Covered entities now will have another year to prepare for the transition from ICD-9 to ICD-10 codes.


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