Spotlight on Recent Federal Regulatory Actions

CMS’s proposed rule to simplify the Medicaid and Children’s Health Insurance Program (“CHIP”) eligibility process and solicitation for public comment on the creation of a nationwide provider database will impact states, payers, and providers. increase. To inform public comment developments, this article summarizes the key elements of these recent agency publications.

Medicaid Eligibility Notice for Proposed Rulemaking

On September 7, 2022, the Centers for Medicare & Medicaid Services (“CMS”) announced that it will “streamline the application, eligibility determination, enrollment, and renewal processes for Medicaid, children’s health insurance programs, and basic health programs.” issued a draft rule entitled Federal Register.¹ This proposed rule is CMS’s response to the Biden administration’s April 2022.² and January 2021³ Executive order to improve access to health insurance. As the title of the proposed rule suggests, CMS will reduce the burden on individuals applying for Medicaid, CHIP, or Basic Health Program (“BHP”) coverage and reduce procedural hurdles to coverage. The focus is on making it easier to maintain

The proposed changes will reduce Medicaid coverage surrenders, increase the predictability and stability of health insurance coverage, and support continuity of care. The proposed rule affects all Medicaid, CHIP, and BHP participants, but there are special provisions for seniors, the blind, the disabled, and eligible beneficiaries of the Medicare Savings Program . If finalized, regulatory changes could necessitate changes to eligibility systems, policies, and potential state regulations during the unwinding period of the public health emergency (“PHE”). I have. PHE is currently approved until January 11, 2023.^Four If the PHE is not extended, prior notice will be issued by Secretary of Health and Human Services Xavier Becerra around November 12, 2022.^Five

Equivalence of requalification criteria for MAGI and non-MAGI populations. CMS is proposing to extend Medicaid eligibility renewal criteria for Modified Adjusted Gross Income (“MAGI”)-based eligibility groups to non-MAGI-based eligibility groups. This means that an individual eligible for Medicaid because of age, blindness or disability will be subject to one renewal decision every 12 months. Please allow at least 30 days to return the state pre-filled form and requested information. You are not required to attend an in-person eligibility interview. In addition, the state must reconsider an individual’s eligibility within 90 days after he returns the pre-filled form.

Standardize the timeframes in which individuals respond to requests for additional information. Current regulations specify timeframes for state Medicaid agencies to make eligibility determinations and renewals, but do not establish standardized timeframes for individuals to provide the additional information requested. Hm. The proposed rule would set the timeframe based on the date the invoice was postmarked or the date the electronic invoice was sent, as follows: For new applicants applying on the basis of disability he has 30 calendar days. Her 30 days for the current beneficiary during the renewal process.⁷

Use of bounced emails for disqualification purposes. CMS does not perform data checks (e.g., health insurance policyholder information) to verify eligibility status, and states return emails or notices of in-state or out-of-state forwarding addresses for Medicaid non-compliance. I propose that it can no longer be used as evidence of eligibility. The State must contact the individual by means other than mail and take additional prescribed steps prior to dismissal.⁸

Streamline enrollment in Medicare Savings Programs. The proposed rule would allow low-income Medicare recipients to Medicare Savings Programs (“MSPs”) to provide Medicaid coverage for Medicare Parts A and B premium payments and cost sharing, depending on the eligible pathway. support streamlined enrollment growth for To accomplish this, the state will initiate his MSP determination process based on Medicare Part D Low Income Subsidy (“LIS”) data from the Social Security Administration, and will require an individual to complete the determination process. Requests for information should be limited. CMS also proposes rules to align the MSP’s income and resource methodology with that of her LIS program.⁹

tip suggestions. In addition to some proposals to streamline CHIP eligibility and renewal, CMS is proposing to eliminate state options to impose a coverage lockout period for non-payment of premiums.^Ten

Public comment period. The public comment deadline was November 7, 2022. CMS is particularly interested in feedback on reasonable compliance periods for states to implement the proposed changes. For example, CMS will seek comments on the state’s potential compliance with the provisions of the final rule within 90 days, 6 months, or 12 months from the effective date.¹¹ The Office of Information and Regulatory Affairs has not yet published a unified agenda of regulatory and deregulatory actions for Fall 2022, but the authors foresee the publication of final rules by Spring 2023.¹²

Request for information on creating a national provider directory

On October 7, 2022, CMS issued a Request for Information (“RFI”).¹³ Solicit public comment on the creation of a standardized and interoperable National Directory of Health Providers and Services (“NDH”) to be developed and maintained by CMS.

CMS recognizes the costs to providers, payers, and patients in terms of the types of information collected, the frequency of updates, and the formats available, and the burden resulting from various provider directory requirements. Provider directories are the primary source for measuring and monitoring the adequacy of provider networks across health insurance programs, and inaccuracies are well documented.¹⁴ CMS seeks comment on the following:

• NDH’s platform and technology for streamlining validation, validation and interoperability of provider directory information, including HL7® Fast Healthcare Interoperability Resources (“FHIR”), Application Programming Interfaces (“APIs”), and integration of provider data; Standard from other CMS systems.
• Incentives and policies to support timely and accurate data reporting and use of NDHs.¹⁶
• A standardized provider directory data element containing information related to social determinants of health.¹⁷
• Implementation considerations, including stakeholder involvement, technical and policy assumptions, and potential risks and challenges.¹⁸

Public comment period. Public comments are due by December 6, 2022. Commenters can selectively comment on questions raised by her CMS in the RFI.¹⁹

Conclusion:

These two public comment opportunities are of interest to the broader healthcare community. The Medicaid Eligibility Rule, as proposed, removes procedural hurdles that could cause interruptions or delays in coverage that affect the continuation of medical services and enrollment in Medicaid-administered states. increase. The inaccuracy of provider directory information across coverage programs has been the subject of several studies and has been a longstanding administrative challenge for both payers and providers. Public comments received on many of the key areas defined by the CMS will inform agency action regarding future rulemaking to establish a national directory of providers.