Centers for Medicare and Medicaid Services (CMS) recently released a proposed rule that has important
implications for Medicaid beneficiaries who require rehabilitative and
habilitative services and devices.
the rule, CMS proposes changes to provide states more flexibility to coordinate
Medicaid and the Children's Health Insurance Program (CHIP) eligibility
notices, appeals, and other related administrative procedures with similar
procedures used by other health coverage programs authorized under the
Affordable Care Act (ACA), such as coordination of benefits between Medicaid
and health plans offered in the health insurance exchanges (Exchanges).
CMS is soliciting comments on whether the habilitative benefit should be
offered in parity with the rehabilitative benefit under the Medicaid program
(as they must be under the Exchanges). Additionally, CMS requests input on
whether the state defined habilitative benefit definition for the Exchanges
should apply to Medicaid or states should be allowed to separately define
habilitative services for Medicaid. Habilitative and rehabilitative benefits
are part of the mandatory essential health benefits (EHB) established by the
ACA to ensure that certain health plans offered in Exchanges provide this
baseline of coverage, benefits, and services to their enrollees.
December 2012, CMS released guidance
to help states align Alternative Benefit Plans under Medicaid programs with the
EHB requirements. In that guidance, CMS stated that it intended for the provisions
of the EHB proposed rule, released on November 20, generally to
apply to Medicaid, but noted that it would address EHB in future rulemaking.
newly released proposed rule also proposes to update and simplify the complex
Medicaid premiums and cost-sharing requirements, to promote the most effective
use of services, and to assist states in identifying cost-sharing flexibilities.
will comment on the proposed rule. Comments are due February 13.