Federal Regulations
February 25, 2011
CMS Proposes Rule to Implement the Community First Choice Option
HHS released a proposed rule implementing Section 2401 of the ACA, which establishes a new mechanism for states to provide home and community based attendant services and supports under their state plan, through the Community First Choice (CFC) option. Starting in October 2011, the three-year program will allow states to receive a six percent increase in federal matching funds for providing qualifying services and supports to Medicaid-eligible individuals in a community setting, in accordance with a person-centered plan.
Comment Date: April 26, 2011
Link to Proposed Rule
Link to Additional Information
February 17, 2011
CMS Proposes Rule Extending Health Care Acquired Condition Penalties to Providers in State Programs
The proposed rule would implement Section 2702 of the ACA, which directs HHS to issue regulations prohibiting Federal payments to states under Sec. 1903 of the Social Security Act (SSA) for any amounts expended for providing medical assistance for health care-acquired conditions. It would also authorize states to identify other provider-preventable conditions for which Medicaid payment would be prohibited.
Comment Date: March 18, 2011
Link to Proposed Rule
Link to Additional Information
February 11, 2011
CMS Proposes Rule for Student Health Insurance Coverage under the ACA
In the February 11 Federal Register, CMS published a rule that would establish guidelines for student health insurance coverage under the ACA. In part, the rule would define student health insurance coverage as a type of individual health insurance coverage. CMS also proposes to exempt student health insurance plans from certain requirements of the ACA, when such requirements would have the effect of prohibiting a college or university from offering a student health plan that is otherwise permitted under federal, state, or local law. The proposed rule would extend many of the ACA’s consumer protections to the plans, such as no lifetime limits on coverage, no arbitrary coverage rescissions, and no pre-existing condition exclusions for students under 19.
Comment Date: April 12, 2011
Link to Proposed Rule
Link to Additional Information
February 2, 2011
CMS Proposes New Requirements for Medicare Certified Providers and Suppliers
CMS published a proposed rule requiring Medicare certified providers and suppliers to make available to their Medicare beneficiaries information about their right to file a written complaint about the quality of care they are receiving or have received with the Quality Improvement Organization (QIO) in the state where health care services are being, or were, provided. The proposed rule would also require these suppliers and providers to provide their beneficiaries with written notice of the QIO’s contact information, and certain facilities would need to disclose State agency contact information to all patients.
Comment Date: April 4, 2011
Link to Proposed Rule
Link to Additional Information
January 13, 2011
CMS Proposes Rule on the Hospital Inpatient Value-Based Purchasing Program
CMS published in the Federal Register a proposed rule to implement the Hospital Value-Based Purchasing program found in Section 3001 of the ACA, under which value-based incentive payments will be made in a fiscal year to hospitals that meet the applicable performance standards for that time frame. The program will apply to payments for discharge occurring on or after October 1, 2012.
Comment Dat: March 8, 2011
Link to Proposed Rule
Link to Additional Information
December 23, 2010
HHS Announces New Regulation on Premium Rate Review
HHS published a proposed rule that would implement a provision in ACA that directs HHS, in conjunction with states, to establish a process for the annual review of unreasonable increases in health insurance rates. Under the regulation, all proposed rate increases at or above 10% would be subject to review, and insurers would be required to provide a justification to states and HHS. In addition, states would conduct the reviews. However, if a state lacks the resources or authority to do thorough actuarial reviews, HHS would conduct them.
Comment Date: February 22, 2011
Link to Proposed Rule
Link to Additional Information
November 22, 2010
Proposed Rules on Changes to MA and Part D Programs
CMS published a rule implementing provisions of the ACA that are related to the Medicare Advantage and Prescription Drug Benefit Programs, clarifying various program participation requirements, and setting forth changes to Parts C and D for contract year 2012. CMS also announced the updated star plan ratings for 2011 Medicare health and drug plans, and a three-year demonstration to provide MA plans financial incentives to provide high-quality care.
Comment Date: January 10, 2011
Link to Proposed Rule
Link to Additional Information
November 10, 2010
Proposed Rule on Medicaid Recovery Audit Contractors
CMS published a proposed rule to provide guidance to States related to Federal/State funding of State start-up, operation and maintenance costs of Medicaid Recovery Audit Contractors (Medicaid RACs) and the payment methodology for State payments to Medicaid RACS in accordance with Section 6411 of the ACA. The rule also proposes requirements for states to assure adequate appeal processes, and for coordinating with other contractors and auditors.
Comment Date: January 10, 2011
Link to Proposed Rule
Link to Additional Information
November 8, 2010
Proposed Rule on Federal Funding for Medicaid Eligibility Determination and Enrollment Activities
CMS published a proposed rule to modify existing definitions and regulations to provide states with a 90 percent enhanced FMAP for the design, development and installation or enhancement of eligibility systems until December 31, 2015, and with a 75 percent FMAP available for maintenance and operations beyond that date.
Comment Date: January 7, 2011
Link to Proposed Rule
Link to Additional Information
October 22, 2010
Proposed Rule on Requirements for Long-Term Care Facilities
CMS published a proposed rule to revise the requirements that an institution would have to meet in order to qualify to participate as a skilled nursing facility in Medicare (SNF) or as a nursing facility (NF) in Medicaid. Specifically, CMS is proposing that SNFs and NFs choosing to have hospice care provided by a Medicare-certified hospice in their facility would be required to ensure that the hospice services met professional standards and principles, in part by having in place a written agreement specifying the roles and responsibilities of each entity.
Comment Date: December 21, 2010
Link to the Proposed Rule
Link to Additional Information