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April 5, 2013

IHS/Tribal/Urban Indian Health Program QHP Addendum Released

On April 5, 2013, the Department of Health and Human Services (HHS) released a final Letter to issuers in the Federal Marketplace.   The Letter provides essential guidance to Marketplace issuers on operational matters, and communicates key dates for the Federal Marketplace for the 2014 plan year.  This guidance may be found here.

In the letter to Issuers, CMS included information regarding the Model Qualified Health Plan (QHP) Addendum, which enables issuers to contract more efficiently with Indian health care providers to ensure that American Indians and Alaska Natives can continue to be served by their Indian provider of choice. It is anticipated that the Model QHP Addendum will assist issuers to meet the QHP certification standards and facilitate acceptance of network contracts by I/T/U providers. CMS strongly encourages issuers and providers to use this Addendum, but use of the Model QHP Addendum is optional.    The Addendum was developed through tribal consultation and the engagement of tribal and issuer input.  You may access a copy of the Addendum here.  In addition, a list of the Indian health providers will be posted in the near future.

April 3, 2013

CMS Releases Proposed Rule on Navigators for FFE & State Partnership Exchanges

The Centers for Medicare & Medicaid Services (CMS) released a proposed rule outlining standards that Navigators in Federally-facilitated and State Partnership Marketplaces must meet, and clarifying earlier guidance about the Navigator program.

Navigators are organizations that will provide unbiased information to consumers about health insurance, the new Health Insurance Marketplace, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program.

“Navigators will be an important resource for consumers who want to learn about and apply for coverage in the new Marketplace,” said CMS Acting Administrator Marilyn Tavenner.

Millions of Americans will be eligible for new coverage opportunities in 2014. For those who are not familiar with health insurance, have limited English literacy, or are living with disabilities, Navigators will serve an important role in ensuring people understand the health coverage options available to them. Navigators will provide accurate and impartial assistance to consumers shopping for coverage plans in the new Marketplace.

Navigators are a significant component of efforts to enroll Americans in the Marketplace. And CMS will ensure that all consumers who need customer service can receive it from trained professionals.  In addition to Navigators, consumers will have access to assistance through services such as a call center, where customer service representatives can provide referrals to the appropriate state or federal agencies, or other forms of assistance programs including in-person assistance personnel, certified application counselors and agents and brokers.

Open enrollment in the Marketplace begins Oct. 1, 2013, with coverage to begin Jan. 1, 2014.

To access the proposed rule released today, click here. 


April 1, 2013

Increased Federal Medical Assistance Percentage Final Rule with Request for Comments & Premium Assistance FAQs

The Centers for Medicare & Medicaid Services (CMS) released information on two topics:

  • Affordable Care Act (ACA) Increased Federal Medical Assistance Percentages
  • Premium Assistance Frequently Asked Questions 

CMS issued a final rule with request for comments titled “Increased Federal Medical Assistance Percentage through the Affordable Care of 2010” (CMS-2327-FC)  on the Federal Register  This rule implements provisions of the ACA on increased Federal Medical Assistance Percentage (FMAP), or matching, rates for certain Medicaid beneficiaries in states. The rule codifies the increased FMAP rates that will be applicable beginning January 1, 2014 and outlines a simplified methodology states will use to claim the appropriate matching rates. A CMS fact sheet describing the rule is available here. Comments are due by Monday, June 3, 2013. To view the final rule, click here.

CMS also released new Frequently Asked Questions (FAQs) about states purchasing coverage through a Qualified Health Plan (QHP) on behalf of their Medicaid beneficiaries using premium assistance.

April 1, 2013

HHS finalizes rule guaranteeing 100 percent funding for new Medicaid beneficiaries

Health and Human Services (HHS) Secretary Kathleen Sebelius today announced a final rule with a request for comments that provides, effective January 1, 2014, the federal government will pay 100 percent of the cost of certain newly eligible adult Medicaid beneficiaries.  These payments will be in effect through 2016, phasing down to a permanent 90 percent matching rate by 2020.  The Affordable Care Act allows states to expand Medicaid to adult Americans under age 65 with income of up to 133 percent of the federal poverty level (approximately $15,000 for a single adult in 2012) and provides unprecedented federal funding for these states.

“This is a great deal for states and great news for Americans,” HHS Secretary Kathleen Sebelius said. “Thanks to the Affordable Care Act, more Americans will have access to health coverage and the federal government will cover a vast majority of the cost.  Treating people who don’t have insurance coverage raises health care costs for hospitals, people with insurance, and state budgets.”

Today’s final rule provides important information to states that expand Medicaid.  It describes the simple and accurate method states will use to claim the matching rate that is available for Medicaid expenditures of individuals with incomes up to 133 percent of poverty and who are defined as “newly eligible” and are enrolled in the new eligibility group.  The system is set up to make eligibility determinations as simple and accurate as possible for state programs.

Under the Affordable Care Act, states that cover the new adult group in Medicaid will have 100 percent of the costs of newly eligible Americans paid for by the federal government in 2014, 2015, and 2016. The federal government’s contribution is then phased-down gradually to 90 percent by 2020, and remains there permanently.  For states that had coverage expansions in effect prior to enactment of the Affordable Care Act, the rule also provides information about the availability of an increased FMAP for certain adults who are not newly eligible.

The rule builds on several years of work that HHS has done to support and provide flexibility to states’ Medicaid programs ahead of the 2014 expansion, including:

  • 90 percent matching rate for states to improve eligibility and enrollment systems;
  • More resources and flexibility for states to test innovative ways of delivering care through Medicaid;
  • More collaboration with states on audits that track down fraud; and
  • Specifically outlining ways states can make Medicaid improvements without going through a waiver process.

For more information on the improvements made to Medicaid, click here.

For the full text of the final rule, click here. 

March 27, 2013

Michigan Health Insurance Exchange Bill Fails-Michigan Defaults to Federally Facilitated Exchange

Although the Michigan State House successfully passed the health insurance exchange bill, which would approve the federal grant funding Michigan received to implement a state partnership exchange (both the federal government and the state collaborate together to establish the exchange), the State Senate failed to pass the bill. As a result, Michigan will default to a federally facilitated exchange (FFE).