Guidance

 

12/12/13 HHS/CMS filed an Interim final rule with comment period- Patient Protection and Affordable Care Act: Maximizing January 1, 2014 Coverage Opportunities." This interim final rule includes policy changes in the Federally-facilitated Marketplace and State Marketplaces that would allow additional enrollment opportunities for qualified individuals and qualified employers seeking health insurance coverage beginning January 1, 2014. The rule also includes clarifications regarding the payment of plan premiums. The rule generally allows individuals to select a qualified health plan (QHP) until December 23, 2013 (but permits State Marketplaces to select a different date), through any Marketplaces for an effective coverage date of January 1, 2014. The rule also extends until December 31, 2013 the date by which enrollees must pay their initial premium to ensure coverage for January 1, 2014. The rule does not change the plan selection or premium payment dates for coverage offered outside of the Exchanges; the policy changes in the rule only apply to the individual market and Small Business Health Options Program (SHOP) in both the Federally-facilitated Marketplaces and State Marketplaces.

 

In Massachusetts, the deadline for applicants to select a QHP and submit payment through the Commonwealth Health Connector (State Marketplace) has always been December 23, 2013. Payments for these plans must be submitted by December 23, 2013 in order to enroll in coverage for January 1, 2014.  

 

Comments are due December 23, 2013.

 

Read the rule (which was published in the Federal Register on December 17, 2013) at: http://www.gpo.gov/fdsys/pkg/FR-2013-12-17/pdf/2013-29918.pdf

 

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

  

News

 

12/11/13 HHS announced that $58 million in in HRSA (Health Resources and Services Administration) Outreach & Enrollment Assistance grants were awarded nationally to health centers to enroll Americans in the new health insurance coverage options made available through the ACA. The awards, authorized under ACA §10503, will allow 1,157 health centers to expand their enrollment assistance efforts.

 

Thirty-five Massachusetts health centers were awarded a combined $875,000 in 2014 and $3,448,106 in 2013. According to HRSA, Massachusetts has 35 health centers with 293 sites that served 638,623 patients last year.

 

Read the press release at: http://www.hhs.gov/news/press/2013pres/12/20131211b.html

For a list of health centers awarded Outreach and Enrollment funds in Massachusetts, visit: http://www.hrsa.gov/about/news/2013tables/outreachandenrollment/ma.html

 

12/12/13- 12/13/13 The Medicaid and CHIP Payment and Access Commission (MACPAC) met to discuss key issues in the Medicaid and CHIP programs, the interactions between Medicaid, CHIP and the Health Insurance Exchanges under ACA §1311(b), changes in Medicaid and CHIP eligibility and cost sharing issues and to plan for the Commission's next report to Congress.

 

MACPAC Commissioners reviewed several policy proposals and highlighted seven recommendations that they will endorse in the Commission's March 2014 Report to Congress. Among the recommendations: the creation of a statutory option for 12-month continuous eligibility for adults in Medicaid (to match children's policy); alignment of coverage of pregnant women by requiring that states provide the same benefits to pregnant women who are eligible for Medicaid on the basis of their pregnancy that are furnished to women whose Medicaid eligibility is based on their status as parents of dependent children; and the elimination of waiting periods for CHIP (to promote continuity of coverage).  

 

MACPAC was established by the Children's Health Insurance Program Reauthorization Act and later expanded and funded through ACA §2801 and §10607. The commission consists of experts, government officials, executives and medical professionals. MACPAC is tasked with reviewing state and federal Medicaid and CHIP access and payment policies and making recommendations to Congress, the HHS Secretary, and the states on a wide range of issues affecting Medicaid and CHIP populations, including health care reform. 

 

View the agenda at:

http://www.macpac.gov/home/meetings/agenda-december-2013-meeting

 

12/3/13 The Patient-Centered Outcomes Research Institute (PCORI) Board of Governors convened and approved the development of new targeted funding announcements (to be released in 2014) and reauthorized PCORI's first four advisory panels. Created under ACA §6301, PCORI is an independent nonprofit organization, tasked with conducting patient-centered outcomes research and studies.

 

Identified as priority research topics by the advisory panels, the newly developed funding announcements will be in the areas of transitional care for patients with complex chronic conditions and obesity treatment in primary care settings. PCORI is seeking applicants for the two new panels.

 

Established in March 2013, the advisory panels are comprised of patients and other stakeholders and help refine and prioritize specific research questions. During the meeting, the Board reauthorized PCORI's first four advisory panels: 1) Assessment of Prevention, Diagnosis, and Treatment Options, 2) Improving Healthcare Systems, 3) Addressing Disparities and 4) Patient Engagement. In addition to the four standing panels, PCORI is soliciting applicants for two new panels (rare disease and clinical trials), required by PCORI's authorizing legislation and approved by the Board of Governors in mid-November, 2013. The new panels will meet for the first time in the spring of 2014.

 

For more information about PCORI, visit www.pcori.org

For application information about the application process for the advisory panels, visit: http://www.pcori.org/get-involved/advisory-panels/

For more information about PCORI funding opportunities, visit:

www.pcori.org/funding-opportunities.

View the archived December 3, 2013 meeting materials at:

http://encore.meetingbridge.com/MB005418/131203_12pm/

 

Commonwealth of MA News

 

MassHealth and Health Safety Net Regulation Changes

EOHHS has promulgated MassHealth and Health Safety Net regulations (with an effective date of January 1, 2014) to implement the Affordable Care Act (ACA). The proposed changes will affect MassHealth and Health Safety Net eligibility, benefits, and operational processes. Specifically, the regulation changes implement the categorical and financial requirements for MassHealth programs authorized by the ACA and changes in Massachusetts state law. In addition, the proposed regulations describe operational changes in the application and redetermination processes.

 

After taking into consideration all public comments and testimony regarding the proposed regulations, EOHHS published the final regulations in the Massachusetts Register on December 20, 2013, with the January 1, 2014 effective date. The regulations will also be posted online at http://www.mass.gov/eohhs/gov/laws-regs/masshealth/regulations/