Regulations & Guidance

Regulations and guidance are used to implement many of the Affordable Care Act provisions that address both private and public health insurance.

Open for Public Comment

• Medicare - Request for Applications: Interim Final Rule on Advanced Payment Model (Issued by the Centers for Medicare & Medicaid Services)
  Visit the Center for Medicare and Medicaid Innovation website to find the latest application and deadline information.
• Medicare, Medicaid, and CHIP - Request for Applications for the Bundled Payments for Care Improvement Initiative (Issued by the Centers for Medicare & Medicaid Services)
  Visit the Center for Medicare and Medicaid Innovation website to find the latest application and deadline information.

Other Regulations & Guidance

• Final Rule on Health Insurance Premium Tax Credits (PDF - 324 KB) (Issued by the Department of the Treasury)
  Comments closed: August 21, 2012
• Proposed Rule: Women's Preventive Services Under the Affordable Care Act (Issued by the Department of Health and Human Services, Department of the Labor, and the Department of the Treasury)
  Comments closed: June 19, 2012
• Final Rule on the Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers (Issued by the Department of Health and Human Services)
  Note: Certain provisions of this final rule are being issued as interim final.
  Comments closed: May 11, 2012
• Final Rule on Medicaid Eligibility Under the Affordable Care Act (Issued by the Centers for Medicare & Medicaid Services) Note: Certain provisions of this final rule are being issued as interim final.
  Comments closed: May 7, 2012
• Employer Bulletin: FAQs on Automatic Enrollment, Employer Responsibility, and Waiting Periods (Issued by the Department of Health and Human Services, Department of the Labor, and the Department of the Treasury)
  Comments closed: April 9, 2012
• Final Rule on Student Health Insurance Coverage (Issued by the Centers for Medicare & Medicaid Services)
• Final Rule on Standards Related to Reinsurance, Risk Corridors, and Risk Adjustment (Issued by the Department of Health and Human Services)
• Medicaid - Final Rule on Review and Approval Process for Section 1115 Demonstrations (Issued by the Department of Health and Human Services)
• Interim Final Rule on Administrative Simplification: Adoption of Standards for Health Care Electronic Funds Transfers and Remittance Advice (Issued by the Department of Health and Human Services)
  Comments closed: March 12, 2012
• Final Rule on Application, Review, and Reporting Process for Waivers for State Innovation (Issued by the Department of Health and Human Services)
• Final Rule on Women's Preventive Services - Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services Under the Patient Protection and Affordable Care Act (Issued by the Department of Health and Human Services, Department of the Labor, and the Department of the Treasury)
• Final Rule on the Summary of Benefits and Coverage and Uniform Glossary (Issued by the Department of Health and Human Services, Department of the Labor, and the Department of the Treasury)
• Final Rule on the Summary of Benefits and Coverage and Uniform Glossary: Templates, Instructions, and Related Materials - Guidance for Compliance (Issued by the Department of Health and Human Services, Department of the Labor, and the Department of the Treasury)
  See examples and samples of the template at CCIIO.CMS.gov.
• Essential Health Benefits - Informational Bulletin (Issued by the Department of Health and Human Services)
  Comments closed: January 31, 2012.
• Medicare - Request for Public Comment on Final Waivers in Connection with the Shared Savings Program (Issued by the Centers for Medicare & Medicaid Services)
  Comments closed: January 3, 2012
• Medicare and Medicaid - Proposed Rule on Reform of Hospital and Critical Access Hospital Conditions of Participation (Issued by the Centers for Medicare & Medicaid Services)
  Comments closed: December 23, 2011
• Medicare and Medicaid - Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (Issued by the Centers for Medicare & Medicaid Services)
  Comments closed: December 23, 2011
• Medicare - Proposed Changes to the Medicare Advantage and the Medicare Prescription Drug Benefit Programs for Contract Year 2013 and Other Proposed Changes; Considering Changes to the Conditions of Participation for Long Term Care Facilities (Issued by the Centers for Medicare & Medicaid Services)
  Comments closed: December 12, 2011
• Final Rule on CO-OPs - Establishment of Consumer Operated and Oriented Plan (CO-OP) Program (Issued by the Department of Health and Human Services)
• Proposed Rule on Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers (Issued by the Department of Health and Human Services)
  Comments closed: October 31, 2011
• Medicaid – Proposed Rule on Eligibility Changes under the Affordable Care Act of 2010 (Issued by the Centers for Medicare and Medicaid Services)
  Comments closed: October 31, 2011
• Notice of Proposed Rulemaking on Health Insurance Premium Tax Credits (Issued by the Department of the Treasury and the Internal Revenue Service)
  Comments closed: October 31, 2011
• Establishment of Exchanges and Qualified Health Plans (Issued by the Centers for Medicare and Medicaid Services)
  Comments closed: October 31, 2011
• Standards Related to Reinsurance, Risks Corridors and Risk Adjustment (Issued by the Centers for Medicare and Medicaid Services)
  Comments closed: October 31, 2011
• Notice of Proposed Rulemaking on the Summary of Benefits and Coverage and Uniform Glossary (Issued by the Department of the Treasury, Department of Labor, and the Department of Health and Human Services)
  Comments closed: October 21, 2011
• Request for Public Comment on Templates, Instructions, and Related Materials under the Public Health Service Act (Issued by the Department of the Treasury, Department of Labor, and the Department of Health and Human Services)
  Comments closed: October 21, 2011
• Medicare - Final Rule on Shared Savings Program: Accountable Care Organizations (Issued by the Centers for Medicare & Medicaid Services)
• Medicare -Final Rule on Changes to the Ambulatory Surgical Centers Patient Rights Conditions for Coverage (Issued by the Centers for Medicare and Medicaid Services)
• Group Health Plans and Health Insurance Issuers Relating to Coverage of Preventive Services under the Patient Protection and Affordable Care Act (Issued by the Department of Health and Human Services, the Employee Benefits Security Administration, and the Internal Revenue Service)
  Note: Updated February 15, 2012. See Final Rule.
• HRSA-Supported Women's Preventive Services: Required Health Plan Coverage Guidelines
• Medicaid – Final Rule on the Medicaid Recovery Audit Contractor (RAC) Program (Issued by the Centers for Medicare & Medicaid Services)
• Rate Increase Disclosure and Review: Definitions of “Individual Market” and “Small Group Market (Issued by the Department of Health and Human Services)
• CO-OPs - Establishment of Consumer Operated and Oriented Plan (CO-OP) Program (Issued by the Department of Health and Human Services)
• Administrative Simplification - Interim Final Rule on the Adoption of Operating Rules for Eligibility for a Health Plan and Health Care Claim Status Transactions (Issued by the Centers for Medicare and Medicaid Services)
• Health Insurance Rate Review – Final Rule on Rate Increase Disclosure and Review (Issued by the Centers for Medicare and Medicaid Services)
• Medicare – Final Rule on Hospital Inpatient Value-Based Purchasing (Issued by the Centers for Medicare and Medicaid Services) Correction of final rule.
• Medicaid – Final Rule on Federal Funding for Medicaid Eligibility Determination and Enrollment Activities (Issued by the Centers for Medicare and Medicaid Services)
• Medicaid – Notice of Proposed Rulemaking on Home and Community-Based Services Waivers (Issued by the Centers for Medicare and Medicaid Services)
• Food Labeling - Notice of Proposed Rulemaking on Calorie Labeling of Articles of Food in Vending Machines (Issued by the Food and Drug Administration) Correction of proposed rule.
• Food Labeling - Notice of Proposed Rulemaking on Nutrition Labeling of Standard Menu Items in Restaurants and Similar Retail Food Establishments (Issued by the Food and Drug Administration) Correction of proposed rule.
• Accountable Care Organizations - Notice of Proposed Rulemaking on Accountable Care Organizations (Issued by the Centers for Medicare & Medicaid Services)
• Health Insurance Rate Review NPRM (Issued by the Office of Consumer Information and Insurance Oversight)
• Supplemental Guidance on Consumer Notices on Waivers of the Annual Limits Requirements (PDF – 53 KB) (Issued by the Office of Consumer Information and Insurance Oversight)
• Supplemental Guidance on Sale of New Business by Issuers Receiving Waivers (PDF- 54 KB) (Issued by the Office of Consumer Information and Insurance Oversight)
• Medical Loss Ratio - Interim Final Rule (Issued by the Office of Consumer Information and Insurance Oversight). Correction of interim final rule. View State MLR adjustment applications and public comments.
• Initial Guidance to States on Exchanges (Issued by the Office of Consumer Information and Insurance Oversight)
• Amendment to Regulation on “Grandfathered” Health Plans under the Affordable Care Act (Issued by the Office of Consumer Information and Insurance Oversight)
• Medicaid - Notice of Proposed Rulemaking on Federal Funding for Medicaid Eligibility Determination and Enrollment Activities (Issued by the Centers for Medicare & Medicaid Services)
• Medicaid - Notice of Proposed Rulemaking on the Medicaid Recovery Audit Contractor (RAC) Program (Issued by the Centers for Medicare & Medicaid Services)
• Regulation on Pre-Existing Condition Insurance Plan (Issued by the Office of Consumer Information and Insurance Oversight)
• Request for Comment on Health Insurance Exchanges (Issued by the Office of Consumer Information and Insurance Oversight)
• Regulation on Consumers' Right to Appeal Health Plan Decisions (Issued by the Office of Consumer Information and Insurance Oversight)
• Preventive Services: Regulations and Recommendations
• Patient’s Bill of Rights (Issued by the Office of Consumer Information and Insurance Oversight)
• Regulation on “Grandfathered” Health Plans under the Affordable Care Act (Issued by the Office of Consumer Information and Insurance Oversight)
• Dependent Coverage of Children Who Have Not Attained Age 26 (Issued by the Office of Consumer Information and Insurance Oversight)
• Early Retiree Reinsurance Program (Issued by the Office of Consumer Information and Insurance Oversight)
• Health Care Reform Insurance Web Portal Requirements (Issued by the Office of Consumer Information and Insurance Oversight)
• COBRA Continuation of Coverage (Issued by the Centers for Medicare & Medicaid Services)
• Health Insurance Reform for Consumers (Issued by the Centers for Medicare & Medicaid Services)
• Health Insurance Reform for Employers (Issued by the Centers for Medicare & Medicaid Services)
• Self-Funded Nonfederal Governmental Plans (Issued by the Centers for Medicare & Medicaid Services)
• Affordable Care Act Expands Prevention Coverage for Women’s Health and Well-Being
• Annual Limits Policy: Protecting Consumers, Maintaining Options, and Building the Bridge to 2014
• More Information on Prevention Regulations and Guidance
• Preventive Regulations
• New Resources to Help States Crack Down on Unreasonable Health Insurance Premium Hikes
• Recommended Preventive Services
• U.S. Preventive Services Task Force Recommendations

Regulatory Resources

• If you cannot find the regulation that you are looking for, use the search tool available at Regulations.gov.
• For information on regulations on the day they are issued, visit the Federal Register’s Public Inspection Desk (See Special Filing or Regular Filing).
• The Internal Revenue Service (IRS) is responsible for tax provisions of the Affordable Care Act that will be implemented during the next several years. A list of these provisions now in effect, and additional information soon to be added, can be found at www.irs.gov.
• The Center for Consumer Information and Insurance Oversight (CCIIO) oversees the implementation of Affordable Care Act provisions that are related to private health insurance. Detailed technical and regulatory information on the health care law can be found at cciio.cms.gov (See Regulations & Guidance section).