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A proposed rule released by the Centers for Medicare and Medicaid Services (CMS) on November 30, details specific information related to the implementation of key areas of the Affordable Care Act designed to help keep health insurance affordable and accessible to all Americans.  It offers specific information about how CMS proposes certain insurance affordability programs such as advance payments of the premium tax credit and cost-sharing reductions, should operate. The rule also specifies how the various premium stabilization programs will work to reduce the risk to insurers should the health care costs of enrollees exceed what is expected, thus keeping health insurance premiums low. Additional information included in the regulation include a proposed user fee for health insurance issuers participating in a Federally-facilitated Exchange and details on the Small Business Health Options program. Comments on the proposed rule are due by December 31, 2012.