The U.S. Department of Health and Human Services (HHS) published a final rule in the July 17, 2013 Federal Register on Exchange consumer assistance programs, including Navigators, in-person assisters, and certified application counselors. The final rule is authorized under section 1311 of the Affordable Care Act. It follows an April 5, 2013 proposed rule on conflict of interest, training, certification, and access standards for Navigators and in-person assisters as well as a January 22, 2013 proposed rule on certified application counselors. Required consumer assistance training content includes topics such as coverage options, premium assistance, tax implications of enrollment decisions, eligibility and enrollment procedures, safeguarding the confidentiality of personally identifiable information, working effectively with disabled persons and persons with limited English language proficiency, outreach strategies, and appropriate customer service standards. [More]
On Monday, July 22, 2013, the U.S. Department of Justice (DOJ) filed a lawsuit in Federal District Court in Fort Lauderdale, Florida, alleging that the state was violating the Americans with Disabilities Act (ADA) by unnecessarily segregating 200 children with disabilities in nursing facilities when they could be served in their family homes or other community-based settings. [More]
On July 11, 2013, Stuart Wright, Deputy Inspector General for Evaluation and Inspections sent an early alert memorandum to George Sheldon, Acting Secretary, Administration for Children and Families (ACF), outlining results of data collection for an evaluation entitled, “Child Care and Development Fund: Monitoring of Licensed Child Care Providers.” [More]
On July, 8, 2013, the Centers for Medicare & Medicaid Services (CMS) placed on display at the Federal Register a major proposed rule containing the CY 2014 Medicare Physician Payment Schedule. Under section 1848 of the Social Security Act, CMS is required to establish payments under the Medicare Physician Fee Schedule based on national relative value units (RVUs) that account for the relative resources used in furnishing a medical service. [More]
Various media reports indicate that the recent delay of the Affordable Care Act’s (ACA’s) employer mandate may give rise to Congressional legislative attempts to postpone other key provisions of the ACA, especially the individual mandate. The alleged rationale for proposing additional delays, including the individual mandate, is the perception that the employer mandate could be viewed as favoring “big business” over uninsured Americans. [More]
The U.S. Department of Health and Human Services (HHS) issued a draft final rule on July 5, 2013 on health insurance Exchange eligibility/enrollment procedures and Medicaid/CHIP eligibility notices, fair hearings, premiums, cost-sharing, and alternative benefit plans. The final rule is scheduled for official publication in the Federal Register on July 15, 2013. It allows State Medicaid agencies to delegate MAGI-related Medicaid eligibility determinations and appeals to the Exchange via a formal agreement if the Exchange is a government agency operating under a merit personnel system; and, if so, appellants must be given a choice whether to have their appeals heard at the State Medicaid agency or at the Exchange. [More]
The Centers for Medicare and Medicaid Services (CMS) issued a final rule on July 1, 2013 on determining eligibility for exemptions to the “individual mandate” under the Affordable Care Act. Individuals without exemptions will incur tax penalties beginning with their IRS tax filings in 2015 for tax year 2014 if they don’t maintain at least some form of “minimum essential coverage” after January 1, 2014. Tax penalties will be $95 for tax year 2014, $325 for 2015, and $695 annually for 2016 and subsequent years. [More]
The U.S. Treasury released proposed rules on July 2, 2013 on monthly and annual reporting requirements for Exchanges related to the administration of advance payments of tax credits under the Affordable Care Act. The proposed rules would require Health Insurance Exchanges to file monthly reports electronically with the US Department of Health and Human Services and the Internal Revenue Service by the 15th of each month and to file annual reports by January 31 of each year for individuals obtaining coverage through Exchanges in the preceding year. [More]
The U.S. Treasury posted a notice on July 2, 2013 acknowledging delay in publishing rules to implement employer and insurer reporting requirements under sections 6055 and 6056 of the Internal Revenue Code as amended by the Affordable Care Act (ACA). Such rules are necessary to determine whether large and medium employers (employers with more than 50 full-time employees) not offering affordable health coverage for their employees will be subject to tax penalties under the Internal Revenue Code. The July 2 notice indicates that such employer tax penalties will not be imposed for 2014 and that additional information will be available soon about the IRS timetable for publishing proposed rules and reporting requirements for 2015. [More]
Since the Supreme Court ruled that Medicaid expansion was optional, 23 states plus the District of Columbia have decided to go forward with the expansion and 21 have decided to pass, with six still debating the issue, according to a Kaiser Family Foundation report.
With respect to the six states still debating the issue, the Ohio legislature appears ready to sign off on a two-year budget that does not include plans for Medicaid expansion. In Pennsylvania, the Senate is expected to vote next week on the expansion issue, but state media reports indicate a lack of support for expansion in the House.