Resources from the Federal Government

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Proposed Rule: State Disproportionate Share Hospital Allotment Reductions

May 2013

The Centers for Medicare and Medicaid Services (CMS) released a proposed rule on DSH payments. The proposed rule specifies the methodology for the annual reductions in DSH payments from fiscal year 2014 through fiscal year 2020, as required by the ACA. The rule also outlines some additional proposed DSH reporting requirements. A fact sheet is also available.

 

Notice of Proposed Rulemaking - Computation of, and Rules Relating to, Medical Loss Ratio

May 2013

The IRS released proposed regulations that provide guidance to Blue Cross and Blue Shield organizations, and certain other health care organizations, on computing and applying the medical loss ratio as detailed in the Affordable Care Act (ACA). That provision requires carriers to apply at least 80 percent of paid premiums to health care services and up to 20 percent to administrative costs. 

 

Application for Health Coverage

May 2013

CMS released a set of streamlined applications for individuals and families seeking health coverage. These applications will help individuals and families determine whether they qualify for Medicaid, the Children’s Health Insurance Program, plans offered on the exchange, and tax credits to help cover the costs of premiums. 

 

FAQ: Enhanced Funding for Medicaid Eligibility Systems Operation and Maintenance

May 2013
Under the Medicaid program, states are eligible to receive 90 percent federal matching funds for the design and development of ACA-compliant Medicaid eligibility determination systems and 75 percent federal matching funds for maintenance and operations. This set of FAQs provides general guidelines about what costs are eligible for enhanced funding and how CMS will work with each state to review and approve the costs that will be covered.
 
 

Role of Agents, Brokers, and Web-brokers in Health Insurance Marketplaces

May 2013

This three-part document provides a high-level overview of the role of agents and brokers in Federally-facilitated and State Partnership Marketplaces, also known as exchanges. It addresses common questions raised by states and other stakeholders on the role of agents and brokers in all Marketplaces – including State-based Marketplaces.  It also includes process flows for both pathways.

 

Proposed Rule: Minimum Value of Eligible Employer-Sponsored Plans

May 2013

This proposed rule released by the IRS provides further detail on the minimum value that employer-sponsored coverage must provide in order to comply with the ACA and not be subject to the employer mandate penalty. It also provides additional guidance on premium tax credits.

 

Navigator Funding Opportunity Announcement

Apr 2013

The Department of Health and Human Services has released this funding opportunity announcement for individuals or entities interested in applying to serve as navigators in the federally facilitated or state partnership exchanges.

 

Basic Health Program: Timeline

Apr 2013

HHS released the timeline for the Federal Basic Health Plan, laying out the steps for its launch in 2015. According to the timeline, the Federal Basic Health Plan will begin enrollment in October 2014 and begin operations in January 2015.

 

Medicaid and the Affordable Care Act: Premium Assistance

Apr 2013

In this 2-page FAQ, CMCS reviews the premium assistance option under Medicaid. It also provides further detail for states interested in submitting demonstration proposals for providing premium assistance in the individual market.

 

Non-Exhaustive List of Essential Community Providers

Apr 2013

HHS has published a non-exhaustive database of essential community health providers (ECPs) as outlined in its letter to issuers on federally facilitated and state partnership exchanges. This database is intended to help qualified health plan issuers comply with the ECP requirements of the ACA.

 
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