Individual Responsibility Payment under the Affordable Care Act

On June 26, the U.S. Department of Health & Human Services (HHS) issued a Final Rule, CMS 9958-F, regarding the payment of individual shared responsibility for not obtaining insurance coverage under the Affordable Care Act. The rule:

• Implements functions of the insurance marketplaces including determining eligibility for and granting certificates of exemption from the individual shared responsibility payment described in Section 5000A of the Internal Revenue Code;
• Implements the responsibilities of the HHS Secretary to coordinate with the secretary of the Treasury to designate whether health benefits constitute minimum essential coverage;
• Outlines substantive and procedural requirements that other types of individual coverage must fulfill to be certified as minimum essential coverage; and
• Simultaneously, the Internal Revenue Service issued guidance on determining individuals' eligibility for the premium tax credit under Internal Revenue Code Section 36B, as well as exemptions from shared responsibility payments.

A Proposed Rule was published on February 1.¹ The Final Rule is set for publication in the July 1 Federal Register. The rule takes effect August 26.

¹ 78 Fed. Reg. 7348.