ACAP Weighs In on Wide Range of CMS Regulations
October 31, 2011 marked the due date for comments on a wide range of proposed federal regulations and requests for information, ranging from implementation of Exchanges to determination of eligibility for Medicaid, premium tax credits and risk adjustment methodologies. With input from its members, ACAP commented on each of eight proposed regulation listed at the bottom of this page. ACAP’s comments included the following highlights:
Continuity of Care. In the interests of promoting continuity of coverage and care, ACAP proposed that states be given the option to provide beneficiaries with 12 months of continuous Medicaid eligibility without a waiver from CMS. We also noted that while much progress had been made in aligning the way that Medicaid and Exchanges would look at beneficiaries’ incomes in order to determine eligibility, states should be required to assess income on an annual basis so as to avoid situations where an individual is inappropriately determined ineligible for both Medicaid and Exchange coverage. In addition, ACAP recommended that Exchanges be allowed to certify as licensed those Medicaid and CHIP health plans with enrollees who move into the Exchange and which cover families with split eligibility for the purpose of continuing to cover those individuals and families only.
Reduce barriers to Safety Net Health Plan participation in Exchanges. ACAP strongly advocated that CMS reduce barriers to Safety Net Health Plans participating in Exchanges in an effort to promote continuity of care and help families be covered under the same plan. ACAP recommended that the Exchange establishment regulation allow for a five-year transitional period for Safety Net Health Plans to build required reserves, a three-year transitional period to allow unaccredited plans to obtain the required accreditation, and a period to two years to allow Medicaid-focused health plans to gain licensure.
No “wrong door.” ACAP asked CMS to broaden the conditions for which states could delegate authority for determining Medicaid eligibility. Regulations as written would prohibit some Exchanges – those which are public-private partnerships or “quasi-governmental” entities – from determining a beneficiary eligible for Medicaid. In its comments, ACAP asked CMS to allow quasi-governmental Exchanges to determine Medicaid eligibility with an eye towards providing better access for health care consumers.
Promote affordability. CMS also requested feedback on a potential regulation for the Basic Health Program, which is a program ACAP supports. Our recent study with the Urban Institute has shown how the implementation of a Basic Health Program option could make health coverage more affordable and accessible for millions of people, and ACAP urged CMS to develop and propose regulations for public comment sooner rather than later.
Promote program sustainability. ACAP also noted, in comments on the Basic Health program and risk adjustment regulations, that to make the proposed programs sustainable, plans and providers needed to be compensated appropriately. ACAP noted in its comments on the Basic Health Program that actuarially sound rates needed to be established for plans in that program, and that provider payments must be adequate to ensure sufficient networks of participating providers. ACAP also wrote that in both the Exchange and Basic Health Program, risk adjustment mechanisms needed to result in plans being paid capitation rates that adequately cover the risk represented by the populations they served.
Links to individual comments follow.
To review all of ACAP’s comments, visit our Regulations and Comments page.