HHS releases new rules on health reform provisions

The Obama administration released new regulations Monday on some key provisions of the Patient Protection and Affordable Care Act, including Medicaid expansion and state exchanges.

Health and Human Services Secretary Kathleen Sebelius said the proposed rule promotes consistent policies and processes for eligibility notices and appeals in Medicaid, the Children’s Health Insurance Program and exchanges and give states more flexibility when operating their Medicaid programs. HHS said they encourage all Americans to review and submit comments on the proposed rule.

“Before the health care law was passed, millions of Americans were unable to obtain or afford quality health coverage,” Sebelius said in a statement. “Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them.”

The department said the rules—published in a 474-page document—will help develop systems that will make it easy for consumers to determine if they are eligible for Medicaid or tax credits that make insurance more affordable. They also offer states two options for evaluating whether residents have access to employer-sponsored insurance, and for processing appeals of denied claims.

Specifically, the rule would allow states to change their Medicaid programs without a waiver to require an $8 cost share for non-emergency ED use for Medicaid enrollees with incomes of 100 percent to 150 percent of the federal poverty level. States would have no limit on the cost-sharing they could impose on emergency department use for non-emergencies by Medicaid enrollees with incomes over 150 percent of the federal poverty level.  

The rule also laid out the process for appealing eligibility determinations in Medicaid and for the health insurance exchanges.

The department will accept comments on the proposed rule through Feb. 13.

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