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2013-01-19
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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
Part II
Proposed Rules
D09002ee1bdcab3dc
D09002ee1bdcab4de
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
Code of Federal Regulations
Title 42 Part 430
42 CFR Part 430
Code of Federal Regulations
Title 42 Part 431
42 CFR Part 431
Code of Federal Regulations
Title 42 Part 433
42 CFR Part 433
Code of Federal Regulations
Title 42 Part 435
42 CFR Part 435
Code of Federal Regulations
Title 42 Part 440
42 CFR Part 440
Code of Federal Regulations
Title 42 Part 447
42 CFR Part 447
Code of Federal Regulations
Title 42 Part 457
42 CFR Part 457
Code of Federal Regulations
Title 45 Part 155
45 CFR Part 155
Regulation Identification Number 0938-AR04
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
Federal Register
Vol. 78, no. 14
Office of the Federal Register, National Archives and Records Administration
2013-01-22
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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
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2013-01-19
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