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 Legislative & Policy Corner

Tick Tock
As of Dec. 13, Congress and the administration have not yet reached a deal on the fiscal cliff. The countdown to meltdown is getting closer and members of the House and Senate leadership told their members to plan on staying in Washington, DC after the Christmas holiday to work on a deal. According an article in the Washington Post, the Office of Management and Budget is asking federal agencies for more detailed plans on how they plan to administer the across the board cuts known as sequestration if Congress and the administration fail to avert the fiscal cliff. If additional guidance is issued from the feds on this topic, AMCHP will inform our members as soon as that information is made public.

During the past week, AMCHP staff, as part of the Coalition for Health Funding, met with Sen. Patty Murray (D-WA) and Rep. Hoyer (D-MD) to discuss protecting non-defense discretionary spending from further cuts. This week, AMCHP will participate in a conference call with the White House to gather more information about the administration plans to avoid the fiscal cliff. If you have any questions about the fiscal cliff please do not hesitate to contact Carolyn Mullen or Brent Ewig at 202-775-0436.

To Establish or Not?
Friday, Dec. 14 was the deadline for state leadership to indicate their intention to run a state-based health insurance exchange. Earlier this year, the deadline was extended from the end of October at the request of state leaders. As of Dec. 14, 18 states are moving forward with establishing their own exchange, six in partnership with the federal government, 17 established by the federal government, and the remaining leaning toward partnership or state-based. For a map on state positions, click here.

Health Reform Implementation

Feds Release Slew of Highly Anticipated ACA Regulations
After almost a year of not releasing any major regulations, the Obama Administration released a flood of regulations related to the Affordable Care Act (ACA). On Nov. 26, the Centers for Medicare and Medicaid Services (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) published the proposed rule on standards related to essential health benefits (EHB) (summary here). The proposed rule largely follows the bulletin released in December 2011. The rule proposed that states select their own EHB “benchmark” plan from a range of options outlined by HHS and outlines the 10 major categories of benefits that must be covered in the individual and small-group markets – both within and outside of the new health insurance exchanges – including rehabilitative services, habilitative services and devices. This rule keeps with the administration approach to provide flexibility to states in the implementation of EHB and specifically habilitative services. AMCHP is working with members on a guide for states to review and comment on their proposed state EHB plan. CCIIO also published this Guide to Reviewing the State Benchmarks. AMCHP, in collaboration with several coalitions are working to form a response to the proposed rule. Comments are due on Dec. 26, 2012.

AMCHP is working to formulate comments where appropriate but also appreciates hearing from members on their possible reactions to the recent proposed rules.

CMS Issues FAQ Medicaid/CHIP Affordable Care Act Implementation
On Nov. 19, CMS released a FAQ on the implementation of Medicaid and CHIP under the ACA. The document mainly provides technical explanations about interactions between the states and the federally facilitated exchanges, however, there are important details included regarding state/federal responsibilities in either determining or assessing eligibility for Medicaid and CHIP programs.

CMS Issues Fact Sheet on Progress Building the Federally Facilitated Exchange
CMS issued an update on the implementation of the federally facilitated health insurance exchanges (FFEs) on Nov. 30. For the states where leadership decided to forego establishing a state-based health insurance exchange, the federal government will instead establish the health insurance exchange for the state. All exchanges will launch for enrollment in October 2013. The fact sheet provides an update on issues related to eligibility and enrollment, consumer support, plan management, financial management, and the small business health options program application (SHOP).

Kaiser Report on Medicaid Expansion
As states examine the option to expand Medicaid coverage up to 138 percent of the federal poverty level, the Kaiser Commission on Medicaid and the Uninsured released a report on Nov. 30 on the state-by-state and national costs of Medicaid expansion. “This analysis uses the Urban Institute Health Insurance Policy Simulation Model (HIPSM) to provide national, as well as state-by-state, estimates of the impact of the ACA on federal and state Medicaid costs, Medicaid enrollment, and the number of uninsured. The analysis shows that the impact of the ACA Medicaid expansion will vary across states based on current coverage levels and the number of uninsured. It also shows that by implementing the Medicaid expansion with other provisions of the ACA, states could significantly reduce the number of uninsured. Overall state costs of implementing the Medicaid expansion would be modest compared to increases in federal funds, and many states are likely to see small net budget gains.”

CMCS Released Informational Bulletin on Coverage and Service Design Opportunities for Individuals with Mental Illness and Substance Use Disorders
The Centers for Medicaid and CHIP Services (CMCS) released an informational bulletin on Dec. 3 to “provide information regarding services and good practices for individuals with a behavioral health disorder.”