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 2013-07-13 article Part II Rules and Regulations D09002ee1c7fb3f01 D09002ee1c7fb3fe0 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 final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as "alternative benefit plans") to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable. 78 FR 42160 https://www.govinfo.gov/app/details/FR-2013-07-15/2013-16271 2013-16271 fr15jy13-15 RIN 0938-AR04 4120-01-P CMS-2334-F https://www.govinfo.gov/app/details/FR-2013-07-15/2013-16271 https://www.govinfo.gov/content/pkg/FR-2013-07-15/html/2013-16271.htm https://www.govinfo.gov/content/pkg/FR-2013-07-15/pdf/2013-16271.pdf Grant Programs-Health Health Facilities Medicaid Privacy Reporting and Recordkeeping Requirements Aid to Families with Dependent Children Supplemental Security Income (Ssi) Wages Guam Puerto Rico Virgin Islands Accounting Administrative Practice and Procedure 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 Advisory Committees State and Local Governments Sunshine Act Technical Assistance 163 p. 42160 42322 78 FR 42160 Title 42 Part 431 42 CFR Part 431 Title 42 Part 435 42 CFR Part 435 Title 42 Part 436 42 CFR Part 436 Title 42 Part 438 42 CFR Part 438 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 Title 45 Part 156 45 CFR Part 156 RIN 0938-AR04 Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Federal Register Vol. 78, Issue RULE 2013-16271 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Office of the Secretary 2012-03-23 CMS-2334-F 4120-01-P 2013-16271 Final rule.

This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as "alternative benefit plans") to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.

The effective date for the additions of 42 CFR 435.118, 435.603, 435.911, 435.949, 435.956, 435.1200, 457.315, 457.330 and 457.348; amendments to 42 CFR 431.10, 431.11, 435.110, 435.116, 435.119, 435.907, 435.916, 435.940, 435.945, 435.948, 435.952, 457.340 and 457.350; the removal of 42 CFR 435.953 and 435.955; and the redesignation of 42 CFR 435.911 through 435.914 as 42 CFR 435.912 through 435.915 in CMS-2349 (FR Doc. 2012-6560) published on March 23, 2012, which were to become effective in January 1, 2014 are now effective October 1, 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. Melissa Harris, (410) 786-3397, for provisions related to essential health benefits. Leigha Basini, (301) 492-4307, for provisions related to Affordable Insurance Exchanges. Grant Programs-Health Health Facilities Medicaid Privacy Reporting and Recordkeeping Requirements Aid to Families with Dependent Children Supplemental Security Income (Ssi) Wages Guam Puerto Rico Virgin Islands Accounting Administrative Practice and Procedure 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 Advisory Committees State and Local Governments Sunshine Act Technical Assistance Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment , OIRA_submission@omb.eop.gov http://cciio.cms.gov/resources/files/ffe_guidance_final_version_051612.pdf http://cciio.cms.gov/resources/files/Files2/03162012/hie3r-ria-032012.pdf http://cciio.cms.gov/resources/other/Files/AttachmentC_042913.pdf http://cciio.cms.gov/resources/regulations/index.html#gp http://medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-ACA-Implementation/Downloads/FAQ-03-29-13-Premium-Assistance.pdf http://www.aidsinfo.nih.gov http://www.cciio.cms.gov/resources/other/Files/AttachmentC_042913.pdf http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/companion-guide-for-ffe-enrollment-transaction-v15.pdf http://www.cms.gov/Regulations-and-Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing.html http://www.dol.gov/ebsa/pdf/FLSAwithplans.pdf http://www.gpo.gov/fdsys/pkg/FR-2012-03-27/pdf/2012-6125.pdf http://www.medicaid.gov/Federal-Policy-Guidance/Downloads/SHO-13-003.pdf http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SHO12003.pdf http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD-13-002.pdf http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/Downloads/RFI-Performance-Indicators-1-24-13.pdf http://www.medicaid.gov/State-Resource-Center/FAQ-Medicaid-and-CHIP-Affordable-Care-Act-ACA-Implementation/Downloads/Affordable-Care-Act_-Newest-Version.pdf http://www.sba.gov http://www.whitehouse.gov/omb/circulars_a004_a-4/ https://calt.cms.gov/sf/go/doc16369?nav=1 Vol. 78, no. 135 Office of the Federal Register, National Archives and Records Administration 2013-07-15 continuing daily deposited born digital 398 p. Table of Contents: AE 2.7: GS 4.107: AE 2.106: KF70.A2 https://www.govinfo.gov/app/details/FR-2013-07-15 P0b002ee1855eb99e 0097-6326 0042-1219 0364-1406 769-004-00000-9 000582072 f:fr15jy13 https://www.govinfo.gov/app/details/FR-2013-07-15 https://www.govinfo.gov/content/pkg/FR-2013-07-15/pdf/FR-2013-07-15.pdf https://www.govinfo.gov/content/pkg/FR-2013-07-15/xml/FR-2013-07-15.xml fdlp 41999 42387 DGPO 2013-07-13 2024-06-03 FR-2013-07-15 machine generated eng FR FR-2013-07-15 78 135