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  • CMS Seeks Comments on Habilitative Benefit Under Medicaid Program

    The 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.

    In 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).    

    Specifically, 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.

    In 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.

    The 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. 

    APTA will comment on the proposed rule. Comments are due February 13. 


    • Louisiana medicaid program has advised us that as of 2-1-13, there wil be no reimbursement for PT/OT/SPT for Medicaid beneficiaries over the age of 21. How does that fit in with ACA and EHB?

      Posted by marilyn kovar on 1/21/2013 1:56 PM

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