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 Legislative & Policy Corner

Health Reform Implementation
The U.S. Department of Health and Human Services (HHS) announced on Jan. 3 a new batch of states that are conditionally approved to operate state-based health insurance exchanges. Those states are California, Hawaii, Idaho, Nevada, New Mexico, Vermont and Utah. These states are in addition to Colorado, Connecticut, the District of Columbia, Kentucky, Massachusetts, Maryland, Minnesota, New York, Oregon, Rhode Island and Washington that also are conditionally approved to run a state-based exchange. Additionally, conditional approval was given to Delaware to operate a state partnership exchange.

On Jan. 3, the Centers for Medicare and Medicaid Services (CMS) also provided guidance on state partnership exchanges, which is a hybrid format of health insurance exchange where the states assume responsibility in running the exchange in partnership with the federal government.

CMS released an Informational Bulletin on Dec. 28 that provides guidance to states on the Modified Adjusted Gross Income (MAGI) Conversion Guidance. “Effective Jan. 1, 2014, a methodology for determining income based on MAGI will apply to both Medicaid and CHIP eligibility for most enrollees, including pregnant women, children, parents and other caretaker relatives, and the new adult group (as applicable in a state). This new methodology is aligned with the one that will be used to determine eligibility for the premium tax credits and cost sharing reductions available to certain individuals purchasing coverage on the Exchange.” The Georgetown Center for Children and Families has useful article here on the bulletin.

On Dec. 21, AMCHP submitted comments to the Federal Register on the Patient Protection and Affordable Care Act proposed rule on essential health benefits.

CMS also announced on Dec. 21, the release of important information for states on the implementation of the Affordable Care Act provisions to raise payments for services furnished by certain primary care physicians in calendar years 2013 and 2014. Of note, the document explains that effective Jan. 1, 2013, state Medicaid programs can receive a one percentage point increase in federal matching payments for services rated A or B by the U.S. Preventive Services Task Force without requiring enrollees to share any of the costs. In addition, effective Jan. 1, 2013, states are required to pay primary care physicians no less than 100 percent of Medicare payment rates in 2013 and 2014 for primary care services, which is fully funded by the federal government.

On a related note, in order to push back against potential cuts to these payments in fiscal cliff negotiations, on Dec. 12, AMCHP signed onto a letter with the pediatric community to support protecting access to health services for children by preserving the Affordable Care Act payment increase for primary care services financed by Medicaid.

AMCHP encouraged states to comment on proposed essential health benefits benchmark plans. AMCHP provided a memo containing background information and how states can comment that can be found here. Comments were due Dec. 26.