The Department of Health and Human Services has sent to the Office of Management and Budget two final rules--covering Medicaid Recovery Audit Contractors programs and Medicaid adjustments to payment for services related to health care-acquired conditions--which are mandated under the Affordable Care Act.

There is no set timetable for OMB review and approval, which is one of the last steps before publication of rules in the Federal Register. Some rules recently under review were pushed out within weeks while others have been stuck for nearly a year. The final rules follow publication of proposed rules last December.

One of the rules would provide guidance to states related to funding for start-up, operation and maintenance of Medicaid RACs. The rule also includes requirements to assure adequate appeals processes and to coordinate activities with existing Medicaid audit contactors.

The other rule would prohibit Medicaid federal payments to states for any amounts expended for providing medical assistance for health care-acquired conditions, according to the law. The rule also would ensure that prohibition of payment does not result in a loss of access to care or services for Medicaid beneficiaries.

--Joseph Goedert


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