Could More Reform Law Provisions be Delayed?

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The Centers for Medicare and Medicaid Services recently delayed the employer mandate for a year and CMS in a new final rule hints that other delays could be coming.

The final rule sets several new policies for Medicaid and the Children’s Health Insurance Program, including provisions that state health insurance exchanges must implement. At the end of a summary of the lengthy rule’s provisions, CMS adds this: “Finally, this rule provides notice that we are considering, for purposes of the initial open enrollment period for enrollment in a qualified health plan through the exchange, whether various provisions of the Medicaid and CHIP regulations should be effective October 1, 2013, or whether a later effective date is appropriate.”

At least one Oct. 1 deadline was changed in the final rule. A number of commenters on the proposed rule requested a later date for implementing electronic notices, such as a notice of eligibility.  CMS responded in the final rule: “We recognize that states are at different places in the development of their eligibility and enrollment systems, and that the technology needs to be in place to offer beneficiaries and applicants the option to receive notices electronically. We have amended sec. 435.918(a) to delay the requirement to provide notices electronically until January 1, 2015, but permit states to implement October 1, 2013, if their systems are ready.”

The final rule sets new Medicaid eligibility provisions, changes electronic Medicaid and CHIP eligibility notices and delegation of appeals, streamlines Medicaid eligibility rules and sets other requirements to ensure these plans include essential health benefits.

The final rule also sets new processes for verification of eligibility and enrollment in employer-sponsored plans available via exchanges to ensure minimum essential coverage is offered, “This final rule does not address proposed provisions regarding exchange eligibility appeals, to provide additional time for the careful development of standards that can be effectively implemented, particularly for those regarding coordination with Medicaid and CHIP,” according to the rule.

Further, the rule does not address multiple provisions in a proposed rule that was released on January 22, 2013, including some assistance that exchanges would offer during the application process. “”We are focusing on those changes that are most needed to implement the changes made by the Affordable Care Act starting in 2014,” CMS notes in the rule. “We intend to address certain of the other provisions in future rulemaking.”

Text of the rule, being formally published July 15 in the Federal Register, is available here.

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