Resources from the Federal Government

The final rule reducing Medicaid disproportionate share hospital (DSH) payments had few changes from the proposed rule. It cuts $500 million in fiscal 2014 and $600 million in fiscal 2015 allotments. The rule also defines the five factors that will be considered to generate a state-specific reduction allotment amount and establishes additional reporting requirements for the new DSH methodology.

This final rule outlines Exchange standards with respect to eligibility appeals, agents and brokers, privacy and security, issuer direct enrollment, and the handling of consumer cases. It also sets forth standards with respect to a State’s operation of the Exchange and Small Business Health Options Program (SHOP).

This proposed rule provides guidance on the tax credit available to certain small employers that offer health insurance coverage to their employee, detailing eligibility for and calculating the tax credit. Comments on the rule are due by November 25, 2013.

These final regulations provide guidance to individual taxpayers on the liability for the shared responsibility payment for not maintaining minimum essential coverage.

This set of FAQs provides additional clarification on strategies for administering telephonic Medicaid and CHIP applications, how states should handle eligibility renewals in 2014, and who will receive the 75 percent match in eligibility systems. It also provides guidance on MAGI-based eligibility and transitioning children between 100-133 percent of the FPL from CHIP to Medicaid.

On August 15, CMS awarded $67 million in Navigator Cooperative Agreements to 105 entities to serve in the 34 Federally-facilitated and State Partnership Marketplaces. This document lists the recipients of the Navigator grants, grouped by state.

This set of instruments released by the Centers for Medicare and Medicaid provides guidance on the methodology and surveys that CMS will use to assess enrollee satisfaction with the Marketplace and QHPs.

On Friday, July 28, the Centers for Medicare & Medicaid Service (CMS) posted Marketplace Experience and QHP Experience Enrollee Satisfaction Surveys. The survey Paperwork Reduction Act (PRA) packages are available for public comment through August 27.

This rule finalized a slew of regulations related to the structure and operations of Medicaid, CHIP, and exchanges under the ACA. These include eligibility and enrollment requirements for qualified health plans and insurance affordability programs (Medicaid, CHIP, APTCs, and Basic Health Plans). It also detailed minimum standard requirements for Alternative Benefit Plans and changes to eligibility notices and appeals for Medicaid and CHIP. Additionally, it updated the criteria for verification of eligibility and enrollment in employer-sponsored insurance.

This final rule provides standards for federally-funded navigator programs operating in federally facilitated and state partnership exchanges, federally-funded in-person assisters, and certified application counselors (CAC). All exchanges are required to have navigators and CACs, while the requirement to have assisters varies by exchange model. The rule includes standards related to conflict of interest, training and certification, accessibility, and SHOP-only navigators.