Grants and Demonstrations

The ACA provides funding opportunities to transform how health care is delivered, expand access to care and support healthcare workforce training.

Grant Activity

Guidance

9/6/13 HHS/CMS issued a correction to the proposed rule called "Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Hospital Value-Based Purchasing Program; Organ Procurement Organizations; Quality Improvement Organizations; Electronic Health Records (EHR) Incentive Program; Provider Reimbursement Determinations and Appeals." The rule implements portions of the following ACA sections: 3001, 3006, 3014, 3138, 3401, 4104, 10301 and 10324. The document makes technical corrections to the proposed rule and extends the comment period by 10 days.

The proposed rule revises and updates the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2014. According to HHS, the rule updates and streamlines programs that encourage high-quality care in these outpatient settings consistent with policies included in the ACA.

The rule describes the proposed changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, the rule updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Hospital Value-Based Purchasing (VBP) Program. The rule also details revisions to the Quality Improvement Organization (QIO) regulations; changes to the Medicare fee-for-service Electronic Health Record (EHR) Incentive Program; and changes relating to provider reimbursement determinations and appeals.

Comments are now due September 16, 2013.

Read the correction (which was published in the Federal Register on September 6, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-09-06/pdf/2013-21849.pdf

9/5/13 IRS issued a notice of proposed rulemaking called "Information Reporting of Minimum Essential Coverage." The rule implements ACA §1502.

The proposed rule provides guidance on persons who are subject to the information reporting requirement. In addition, the regulations also provide that, in general, the name of each individual enrolled in minimum essential coverage and the name and address of the primary insured or other related person who submits the application for coverage must be reported.

Section 6055 of the Internal Revenue Code (Code) as enacted by ACA §1502 details the annual information reporting requirements applicable to insurers, self-insuring employers and certain other providers of minimum essential coverage.

Comments are due November 8, 2013. 

Read the proposed rule (which was published in the Federal Register on September 9, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-09-09/pdf/2013-21783.pdf 

9/5/13 IRS/Treasury issued a notice of proposed rulemaking called "Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans." The rule implements Section 6056 of the Internal Revenue Code (Code) as enacted by ACA §1514(a).

The proposed rule provides guidance to employers on their compliance with the employer shared responsibility provisions. In addition, the proposed rule also includes direction to employers on the requirement to provide statements to employees so that employees may determine whether they are eligible for premium tax credits.

The proposed regulations relate to the Employer Shared Responsibility provisions under Section 4980H which was added to the IRS Code by ACA §1513. Starting in 2014, under these provisions, if employers with 50 or more full-time employees* do not offer affordable health coverage that provides a minimum level of coverage (§1501) to their full-time employees, they may be subject to an Employer Shared Responsibility payment if at least one of their full-time employees receives a premium tax credit (§1401, §1411) for purchasing individual coverage on one of the new Affordable Insurance Exchanges. The ACA established Affordable Insurance Exchanges (§1311(b)) to provide individuals and small business employees with access to health insurance coverage beginning January 1, 2014. 

*To be subject to the Employer Shared Responsibility provisions, an employer must have at least 50 full-time employees or a combination of full-time and part-time employees that is equivalent to at least 50 full-time employees (for example, 100 half-time employees equals 50 full-time employees). As defined by the statute, a full-time employee is an individual employed on average at least 30 hours per week (so half-time would be 15 hours per week). 

Comments are due November 8, 2013. 

Read the proposed rule (which was published in the Federal Register on September 9, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-09-09/pdf/2013-21783.pdf