CHA News Article

CMS Issues Final Rule Implementing Provisions of the ACA

The Centers for Medicare & Medicaid Services (CMS) has released the final rule that implements various provisions of the Affordable Care Act (ACA). The intent of the final rule is to allow each state substantial discretion in the design and operation of its health insurance exchange, with greater standardization provided where directed by the statute or where there are compelling practical, efficiency or consumer protection issues.

Other key elements of the final rule include: finalizing new Medicaid eligibility provisions, as well as changes to electronic Medicaid and the Children’s Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizing and streamlining existing Medicaid eligibility rules; revising CHIP rules on the substitution of coverage to improve coordination with other coverage; and amending requirements of Medicaid benefit packages that provide benchmark and benchmark-equivalent benefit packages (which CMS is now referring to as “Alternative Benefit Plans”), ensuring the packages include essential health benefits and meet other minimum ACA standards.

The final rule also implements provisions related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for affordable insurance exchanges. Additionally, it 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. The rule also includes transition policies for 2014, as applicable.

The final rule does not address proposed provisions regarding exchange eligibility appeals that would provide additional time for the development of standards to be effectively implemented, particularly for those regarding coordination with Medicaid and CHIP. Additionally, the final rule does not address proposed provisions regarding the CHIP Reauthorization Act of 2009 (CHIPRA), certified application counselors in an exchange or Small Business Health Options Program (SHOP) coordination with individual market exchanges. CMS intends to address these provisions in a future issuance. 

Finally, CMS notes that it is considering, for purposes of the initial open enrollment period for enrollment in a Qualified Health Plan through an exchange, whether various provisions of the Medicaid and CHIP regulations should be effective Oct. 1, 2013, or whether a later effective date is appropriate. CMS states that it is focusing on the provisions most needed to implement the changes made by the ACA starting in 2014.  As previously noted, CMS intends to address other provisions in future rulemaking.