Reed Smith Client Alert

Authors: Debra A. McCurdy Elizabeth Doyle O'Brien-Fabeny Joseph W. Metro Robert J. Hill

In less than one year, Affordable Insurance Exchanges (“Exchanges”) authorized by the Affordable Care Act (“ACA”) are scheduled to be operational, providing a marketplace for the purchase of Qualified Health Plans (“QHPs”) in the individual and small group markets. The Obama Administration has recently accelerated rulemaking and subregulatory guidance associated with the new Exchange/QHP framework, with many of the key details only now being finalized.

The attached client alert focuses upon some of the most significant features of QHPs and related issues, with a particular emphasis on prescription drugs. Included in this alert is a summary of ACA subsidies and associated potential fraud and abuse implications, including the potential for QHPs to be considered as federal health care programs subject to the federal anti-kickback statute. The following topics are also covered:

  • Exchanges and types of plans to be offered through exchanges
  • Essential health benefits
  • Premiums
  • Cost-sharing reductions
  • Premium stabilization programs

Download the .PDF to learn more!