1 / 13

ACA Update Part 1: New Rules and Regulations

ACA Update Part 1: New Rules and Regulations. Federal AIDS Policy Partnership August 7, 2013 Andrea Weddle, Co-chair HIV Health Care Access Working Group. Medicaid Expansion Benefits. Referred to as “Alternative Benefits Package”

awena
Télécharger la présentation

ACA Update Part 1: New Rules and Regulations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ACA Update Part 1:New Rules and Regulations Federal AIDS Policy PartnershipAugust 7, 2013Andrea Weddle, Co-chair HIV Health Care Access Working Group

  2. Medicaid Expansion Benefits • Referred to as “Alternative Benefits Package” • Regulation sets minimum standard – state flexibility to develop robust package • Can develop different benefits packages for different populations • “Medically Frail” population can choose traditional Medicaid benefits • Definition broad - should include PWA • See Final Rule at http://www.ofr.gov/(X(1)S(le1fsc4mockmw1tkuddol4r5))/OFRUpload/OFRData/2013-16271_PI.pdf

  3. Complicated Process • State selects benchmark plan • Add EHB service if not covered • Add required Medicaid services • Option to submit Secretary-approved coverage • States use if want traditional Medicaid benefits Learn More: http://www.medicaid.gov/State-Resource-Center/Eligibility-Enrollment-Final-Rule/Alternative-Benefit-Plans-and-Essential-Health-Benefits.pdf

  4. Retreat onDrug Coverage Requirement • Minimum coverage = number of drugs covered by the benchmark for a drug class or at least one drug in a class, whichever greater • Traditional Medicaid requires coverage of nearly all drugs • Monthly drug limits and prior authorization allowed • Must have process for accessing drugs not on formulary

  5. Coverage for Antiretrovirals Will Combination ARVs be Covered? See US Pharmacopia Drug Classification at: http://www.usp.org/usp-healthcare-professionals/medicare-model-guidelines

  6. New Medicaid Cost Sharing Rules Income Under 150% FPL: • Up to $8 for non-preferred drugs; $4 for preferred drugs • Physician can request non-preferred drug as preferred with justification • Up to $4 for office visits • Up to $8 for nonemergency of the ER • Up to $75 for inpatient stays

  7. Medicaid Cost Sharing II • New rules apply to everyone – not just expansion population • Under 100% not denied for failure to pay (still) • New HAB Guidance – Ryan White A B C D can assist with Medicaid premiums & cost sharing depending on coverage adequacy and cost effectiveness

  8. Take Away:State Advocacy Critical • Educate state Medicaid on importance of comprehensive coverage for people with HIV • Urge coverage of ARVs according to federal treatment guidelines, including combination ARVs • Comment on proposed Alternative Benefits Package

  9. For Details… www.nastad.org Click on “Health Reform” in the feature box www.hivhealthreform.org

  10. More Regulations/Guidance • Certified Application Counselor Guidance: http://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CAC-guidance-7-12-2013.pdf • Employer Mandate Delay Announcement:  http://www.treasury.gov/connect/blog/Pages/Continuing-to-Implement-the-ACA-in-a-Careful-Thoughtful-Manner-.aspx • Patient Protection and Affordable Care Act; Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions http://www.ofr.gov/OFRUpload/OFRData/2013-15530_PI.pdf • Eligibility for Minimum Essential Coverage for Purposes of the Premium Tax Credithttp://www.irs.gov/pub/irs-drop/n-13-41.pdf For a translation of latest rules and policies – check out Timothy Jost’sHealth Affairs Blog: http://healthaffairs.org/blog/author/jost/

  11. Enrollment - Training Resources http://marketplace.cms.gov

  12. New & Improved: • Tool to Evaluate Potential New Coverage Options • State-specific Information • Coverage Information

  13. 55 Days Until Open Enrollment Next HHCAWG Call: August 14th – 4 pm ET HIV/AIDS Bureau Call on ACA Guidance: August 14th – 2:30 pm ET

More Related