January 22, 2013

CMS Issues Proposed Rule on PPACA Medicaid Eligibility

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule to implement a number of provisions under the Patient Protection and Affordable Care Act  (PPACA). The proposed rule includes changes that would provide states more flexibility to coordinate Medicaid, the Children's Health Insurance Program, and insurance exchange eligibility notices and appeals. The rule also proposes to update and simplify complex Medicaid premiums and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. CMS proposed an update of the maximum allowable cost sharing levels and to consolidate redundant provisions in order to create one streamlined set of rules for all Medicaid premiums and cost sharing. Finally, the rule proposes to allow states to establish higher cost-sharing for non-preferred drugs and to impose higher cost-sharing for non-emergency use of the emergency department.