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

10/30/13 The Office of Personnel Management (OPM) published a notice under the Privacy Act of 1974 that announces a proposal to add "External Review Records for Multi-State Plan Program (MSPP)" to its system of health insurance records.

Under ACA §1334, the MSPP requires the OPM, which administers the Federal Employees Health Benefits Program (FEHBP), to contract with at least two Multi-State Plans (MSPs) on each of the Affordable Insurance Exchanges. The MSPP is intended to promote competition in the insurance marketplace and help ensure individuals and small employers have higher quality, affordable health insurance plans from which to choose beginning in 2014. An MSPP issuer may phase in the States in which it offers coverage over four years, but it must offer MSPs on Exchanges in all States and the District of Columbia by the fourth year in which the MSPP issuer participates in the MSPP. Health insurance issuers who wish to offer MSPs will complete an application. Although the MSPP is a federal program it will offer products through the state-level exchanges. In addition to compliance with the ACA's requirements that apply to all qualified health plans (QHPs), MSP's must also comply with applicable FEHBP requirements and be licensed by the states in which they do business. Under the ACA, OPM will negotiate a contract with each multi-state QHP in order for that plan to be certified for participation in that state's Exchange. QHPs are health plans that have been certified by an Exchange, provide essential health benefits (§1301) and follow established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts).

The ACA requires implementation of a uniform, nationally applicable external review process for MSP options, similar to the process administered by OPM under the FEHB Program. This process will ensure that MSP Program contracts are administered consistently throughout all 51 jurisdictions that would be served by an MSP option. In addition to requests for external review, we anticipate that MSP enrollees may contact OPM about inquiries or complaints regarding MSP options, which may have to be referred to other appropriate entities such as State insurance departments, State consumer assistance programs, and the U.S. Department of Health and Human Services.

The purpose of this system of records is to provide a central database through which OPM may conduct external review of adverse benefit determinations under the MSP Program, refer MSP enrollees to other appropriate entities to resolve their inquiries or complaints, and correspond with MSP enrollees.

According to CMS, the proposal will be effective on December 9, 2013 unless the agency receives comments that would result in a revised determination.

Read the notice at: http://www.gpo.gov/fdsys/pkg/FR-2013-10-30/pdf/2013-25725.pdf

10/30/13 The Office of Personnel Management (OPM) published a final rule called "Federal Employees Health Benefits Program and Federal Employees

Dental and Vision Insurance Program: Expanding Coverage of Children;

Federal Flexible Benefits Plan: Pre-Tax Payment of Health Benefits Premiums: Conforming Amendments." The rule amends the Federal Employees Health Benefits Program (FEHB) regulations regarding coverage for children up to age 26 and for children of the same-sex domestic partners of FEHB enrollees. The regulations also allow children of same sex domestic partners to be covered family members under the Federal Employees Dental and Vision Insurance Program (FEDVIP).

The rule is intended to (1) Bring FEHB rules into compliance with changes to health insurance coverage for children under the ACA; (2) extend FEHB and FEDVIP benefits to children of same-sex domestic partners of Federal employees consistent with Executive action; and (3) to implement ACA-required changes to the Federal Benefits Plan: Pre-Tax Payment of Health Benefits Premiums in connection with the extension of FEHB coverage to children of same-sex domestic partners of Federal employees.

ACA §2714 requires group health plans and health insurance issuers offering group or individual health insurance coverage that provides dependent coverage of children to ''continue to make such coverage available for an adult child until the child turns 26 years of age.'' Pursuant to the ACA, OPM issued guidance to FEHB carriers in Carrier Letter No. 2010-18 and to agency benefit officers in Benefits Administration Letter No. 10-201. In these guidance documents, OPM explained that the ACA and its implementing regulations allow married children to be covered; remove dependency requirements; remove residency requirements; and do not require a child to be a student or to have prior or current insurance coverage in order to be placed on their parent's enrollment under the FEHB Program.

The proposed rule issued on July 20, 2012 updates FEHB regulations to align with current program policy by extending coverage to children up to 26 years of age, regardless of their marital status, dependency, residency, student status, or lack of insurance coverage with limited exceptions permitted under guidance issued under the ACA.

After reviewing comments the agency received on the proposed rule, OPM made several changes to the final rule. The most significant change to this regulation is that eligibility for the children of same-sex domestic partners is limited to those states in which same-sex couples are unable to marry.

Read the final rule at:

http://www.gpo.gov/fdsys/pkg/FR-2013-10-30/pdf/2013-25734.pdf

10/28/13 HHS/CCIIO issued guidance regarding the ACA's individual shared responsibility provision which clarifies the date by which individuals must be enrolled in health insurance coverage in order to avoid a penalty. According to HHS, individuals will now have until March 31, 2013 (not February 15, 2013 as previously stated) to enroll in health insurance and avoid a penalty (even if the policyholder is not covered by their plan until May 1, 2013).

Beginning in 2014, the individual shared responsibility provision requires each nonexempt individual to have basic health insurance coverage (known as minimum essential coverage, or MEC, §1501), qualify for an exemption, or make a shared responsibility payment when filing their federal income tax return. The requirement applies to adults, children (as tax dependents), seniors (most of whom will meet the coverage requirement through Medicare), and lawfully present immigrants.  

The final regulations (which were published in the Federal Register on August 30, 2013) clarify the rules around those categories of individuals who are either entirely exempt from the requirement to maintain MEC or who are exempt from the associated tax penalty. According to the final regulations, individuals will not have to make a payment if coverage is unaffordable, if they spend less than three consecutive months without coverage, or if they qualify for an exemption for several other reasons, including hardship and religious beliefs. The final regulations also state that a taxpayer is treated as having coverage for a month so long as he or she has coverage for any one day of that month. The final regulations also provide an exemption for those individuals who would be eligible for Medicaid but for a state's choice not to expand Medicaid eligibility (pursuant to the Supreme Court decision).

Read the CCIIO Shared Responsibility Provision Question and Answer at: CMS.Gov