United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2013_register executive 2013-01-19 article Part II Proposed Rules D09002ee1c7fbf323 D09002ee1c7fbf425 United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency United States Office of the Secretary originator org United States Government Agency or Subagency This proposed rule would implement provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act), and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This proposed rule reflects new statutory eligibility provisions; proposes changes to provide states more flexibility to coordinate Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act; modernizes and streamlines existing rules, eliminates obsolete rules, and updates provisions to reflect Medicaid eligibility pathways; revises the rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; implements other CHIPRA eligibility-related provisions, including eligibility for newborns whose mothers were eligible for and receiving Medicaid or CHIP coverage at the time of birth; amends certain provisions included in the "State Flexibility for Medicaid Benefit Packages" final rule published on April 30, 2010; and implements specific provisions including eligibility appeals, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also proposes to update and simplify the complex Medicaid premiums and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. 78 FR 4594 https://www.govinfo.gov/app/details/FR-2013-01-22/2013-00659 2013-00659 fr22ja13-24 RIN 0938-AR04 4120-01-P CMS-2334-P https://www.govinfo.gov/app/details/FR-2013-01-22/2013-00659 https://www.govinfo.gov/content/pkg/FR-2013-01-22/html/2013-00659.htm https://www.govinfo.gov/content/pkg/FR-2013-01-22/pdf/2013-00659.pdf Administrative Practice and Procedure Grant Programs-Health Medicaid Reporting and Recordkeeping Requirements Health Facilities Privacy Child Support Claims Aid to Families with Dependent Children Supplemental Security Income (Ssi) Wages Accounting Drugs Health Professions Rural Areas Health Insurance Advertising Brokers Conflict of Interest Consumer Protection Grants Administration Health Care Health Maintenance Organization (Hmo) Health Records Hospitals Indians Individuals with Disabilities Loan Programs-Health Organization and Functions (Government Agencies) Public Assistance Programs Safety State and Local Governments Technical Assistance Women Youth 131 p. 4594 4724 78 FR 4594 Title 42 Part 430 42 CFR Part 430 Title 42 Part 431 42 CFR Part 431 Title 42 Part 433 42 CFR Part 433 Title 42 Part 435 42 CFR Part 435 Title 42 Part 440 42 CFR Part 440 Title 42 Part 447 42 CFR Part 447 Title 42 Part 457 42 CFR Part 457 Title 45 Part 155 45 CFR Part 155 RIN 0938-AR04 Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals and Other Provisions Related to Eligibility and Enrollment for Exchanges, Medicaid and CHIP, and Medicaid Premiums and Cost Sharing; Federal Register Vol. 78, Issue PRORULE 2013-00659 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Office of the Secretary 2013-02-13 CMS-2334-P 4120-01-P 2013-00659 Proposed rule.

This proposed rule would implement provisions of the Patient Protection and Affordable Care Act of 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act), and the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). This proposed rule reflects new statutory eligibility provisions; proposes changes to provide states more flexibility to coordinate Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices, appeals, and other related administrative procedures with similar procedures used by other health coverage programs authorized under the Affordable Care Act; modernizes and streamlines existing rules, eliminates obsolete rules, and updates provisions to reflect Medicaid eligibility pathways; revises the rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; implements other CHIPRA eligibility-related provisions, including eligibility for newborns whose mothers were eligible for and receiving Medicaid or CHIP coverage at the time of birth; amends certain provisions included in the "State Flexibility for Medicaid Benefit Packages" final rule published on April 30, 2010; and implements specific provisions including eligibility appeals, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also proposes to update and simplify the complex Medicaid premiums and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities.

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on February 13, 2013. Sarah deLone, (410) 786-0615, or Stephanie Kaminsky, (410) 786- 4653, for provisions related to revisions to eligibility notice and fair hearing appeal processes and additional eligibility changes for Medicaid and CHIP. Administrative Practice and Procedure Grant Programs-Health Medicaid Reporting and Recordkeeping Requirements Health Facilities Privacy Child Support Claims Aid to Families with Dependent Children Supplemental Security Income (Ssi) Wages Accounting Drugs Health Professions Rural Areas Health Insurance Advertising Brokers Conflict of Interest Consumer Protection Grants Administration Health Care Health Maintenance Organization (Hmo) Health Records Hospitals Indians Individuals with Disabilities Loan Programs-Health Organization and Functions (Government Agencies) Public Assistance Programs Safety State and Local Governments Technical Assistance Women Youth Medicaid, Children's Health Insurance Programs, and Exchanges: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes for Medicaid and Exchange Eligibility Appeals, etc. , OIRA_submission@omb.eop.gov http://cciio.cms.gov/resources/files/exc-verification-guidance-vach.pdf http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://cciio.cms.gov/resources/files/Files2/11282011/exchange_q_and_a.pdf.pdf http://cciio.cms.gov/resources/regulations/index.html#gp http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/sho010401.pdf http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SHO083109b.pdf http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SHO10006.pdf http://downloads.cms.gov/cmsgov/archived-downloads/SMDL/downloads/SMD10013.pdf http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html http://www.cms.gov/smdl/downloads/SHO10006.pdf http://www.cms.gov/smdl/downloads/SHO122809corrected.pdf http://www.justice.gov/crt/about/cor/lep/hhsrevisedlepguidance.pdf http://www.nashp.org/sites/default/files/maxenroll%20Bachrach%20033011.pdf http://www.regulations.gov http://www.sba.gov http://www.whitehouse.gov/omb/circulars_a004_a-4/ https://www.cms.gov/CMCSBulletins/downloads/Info-Bulletin-4-26-11.pdf https://www.fbo.gov/?s=opportunity&mode=form&id=96c35957187f37da97e40d2c384b666c&tab=core&_cview=0 www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO-12-002.pdf Vol. 78, no. 14 Office of the Federal Register, National Archives and Records Administration 2013-01-22 continuing daily deposited born digital 473 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2013-01-22 P0b002ee183afd46f 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr22ja13 https://www.govinfo.gov/app/details/FR-2013-01-22 https://www.govinfo.gov/content/pkg/FR-2013-01-22/pdf/FR-2013-01-22.pdf https://www.govinfo.gov/content/pkg/FR-2013-01-22/xml/FR-2013-01-22.xml fdlp 4293 4757 DGPO 2013-01-19 2024-06-03 FR-2013-01-22 machine generated eng FR FR-2013-01-22 78 14