6/28/13 Treasury/DOL/HHS issued a final rule called "Coverage of Certain Preventive Services Under the Affordable Care Act." The final rule implements provisions under ACA §1001(2713) that provide women with coverage for preventive care that includes all-FDA approved contraceptive services without cost sharing, while respecting the concerns of certain religious organizations, including certain non-profit religious organizations. Under the final rule non-exempt, non-grandfathered group health plans are required to provide such coverage. Group health plans of "religious employers" are exempted from the requirement to provide contraceptive coverage if they have religious objections to contraception.

The final rule builds on (and reflect the agencies' response to feedback received on) the proposals in the Notice of Proposed Rulemaking (NPRM) published in the Federal Register on February 6, 2013 and requires that most health plans provide women with coverage for recommended preventive care without charging a co-pay, co-insurance or a deductible, while also ensuring that non-profit organizations with religious objections won't have to contract, arrange, pay, or refer for insurance coverage for these services to their employees or students.

On August 1, 2012, certain provisions of §1001(2713) were finalized and about 47 million women gained guaranteed access to additional preventive services without cost sharing. Women's preventive health services include well-woman visits, support for breastfeeding equipment, contraception, and domestic violence screening and counseling.  

The final rule amends the definition of "religious employer" for purposes of determining exemptions from having to provide contraceptive coverage under the preventive services coverage rules. The final rule eliminates the requirements that a religious employer: 1) have the indoctrination of religious values as its purpose, 2) primarily employ employees of the same religious faith and 3) who primarily serve people of the same religious faith. Such employers, primarily houses of worship, may exclude contraceptive coverage from their health plans for their employees and their dependents. The final rule also extends the current, temporary safe harbor for such religious organizations from health plan years beginning August 1, 2013 to January 1, 2013.

The final rule also provides accommodations for non-exempt, non-profit religious organizations that object to contraceptive coverage on religious grounds. Under the accommodations, the eligible organizations do not have to contract, arrange, pay or refer for any contraceptive coverage. The rule establishes accommodations for both insured and self-insured group health plans.

With respect to insured group health plans (including student health plans), eligible religious organizations must provide a copy of a "self-certification form" to its health insurance issuer. The plans must provide separate payments for contraceptive services available to the women in the health plan of the organization (at no cost to the women or organization). HHS expects that providing such payments will be cost-neutral to issuers.

With respect to self-insured group health plans, to be eligible for an accommodation, eligible religious organizations must provide a copy of its "self-certification form" to its third party administrator which would then provide or arrange separate payments for contraceptive services for women in the health plan (at no cost to the women or organization). According to HHS, the costs of the payments can be offset by adjustments in Exchange user fees paid by a health insurance issuer with which the third party administration has an arrangement.

Read the HHS Press release at: http://www.hhs.gov/news/press/2013pres/06/20130628a.html

Read the fact sheet about the final rule at: CMS.Gov

For more information on women's preventive services coverage, visit: HHS.Gov

Read the Updated Guidance on the Temporary Enforcement Safe Harbor at: CMS.Gov

Read the final rule (which was published in the Federal Register on July 2, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-07-02/pdf/2013-15866.pdf

6/27/13 HHS/CMS issued a proposed rule called "Medicare and Medicaid Programs; Home Health Prospective Payment System Rate Update for CY 2014, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey Expenses." The rule implements portions of ACA §3131 and §3401.

The proposed rule updates the Home Health Prospective Payment System (HH PPS) rates, including the national, standardized 60-day episode payment rates, the national per-visit rates, the low-utilization payment adjustment (LUPA) add-on, the non-routine medical supplies (NRS) conversion factor, and outlier payments under the Medicare prospective payment system for home health agencies (HHAs), effective January 1, 2014. As required by the ACA, the rule also proposes rebasing adjustments, with a 4-year phase-in, to the national, standardized 60-day episode payment rates; the national per-visit rates; and the NRS conversion factor.

Finally, the proposed rule would also establish home health quality reporting requirements for CY 2014 payment and subsequent years and would clarify that a state Medicaid program must provide that, in certifying home health agencies, the state's designated survey agency must carry out certain other responsibilities that already apply to surveys of nursing facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF-IID).

Comments are due August 26, 2013.

Read the proposed rule (which was published in the Federal Register on July 3, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-07-03/pdf/2013-15766.pdf

6/28/13 CMS announced that providers and suppliers will have additional time to comply with certain Medicare requirements under ACA §6407. The provision establishes a face-to-face encounter requirement for certain items of durable medical equipment (DME). Under the ACA, a physician is required to document that either a physician, nurse practitioner, physician assistant or clinical nurse specialist has had a face-to-face encounter with the patient. The encounter must occur within the 6 months before the order is written for the DME.

While the provision was originally effective July 1, 2013, CMS announced that the agency will start actively enforcing and will expect full compliance with the DME face-to-face requirements beginning on October 1, 2013. CMS announced the delay because of concerns that some providers and suppliers may need more time to establish the operational protocols necessary to comply with the requirement.

Read the announcement at: CMS.Gov

Prior guidance can be found at: http://www.hhs.gov/healthcare/index.html

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