Editor’s note: This post discusses the first half of a January 14 proposed rule addressing Medicaid and premium tax credit eligibility and appeals, as well as other subjects, under the Affordable Care Act. A second post discussing the rest of the rule is forthcoming.
A very long notice of proposed rulemaking (NPRM) issued on January 14, 2012, by the Centers for Medicare and Medicaid Services of the Department of Health and Human Services suggests that we may be nearing the end of a very active post-election rulemaking season, preparing the way for implementation of the 2014 reforms. HHS must still, of course, finalize the rules it has already proposed, presaging a very active February and March. We can also still expect further important rules from Treasury, which must promulgate rules on the individual responsibility (mandate) requirement and the prohibition against employer discrimination in favor of highly-compensated employees in the offer of insurance.
Also, we are likely to see a continuing stream of guidance and of forms and surveys released as paperwork reduction act notices (three of which were issued January 11). But the January 14 NPRM seems like an effort to tie up a lot of disparate loose ends as the final push begins towards 2014.
The proposed rule, which was issued together with a fact sheet, addresses a number of issues presented by the 2014 transition in the Medicaid, CHIP, and exchange premium tax credit programs. One major concern of the NPRM is the coordination of Medicaid and premium tax credit eligibility determinations and appeals. The original dream of a seamless, streamlined, no-wrong-door Medicaid, CHIP, advance premium tax credit, and cost-sharing reduction payment application and eligibility determination process has become a much more difficult reach with the Supreme Court’s still shocking interpretation of the Constitution’s spending clause, permitting the states to decline participation in the Medicaid expansion, and with a majority of the states declining the invitation to operate a state-based exchange as the bitter political division that has attended the implementation of the ACA shows no signs of abating. The proposed rule attempts to make sense of this mess, recognizing that full coordination of eligibility determination and appeal processes may take awhile.
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