A proposed rule issued Wednesday
includes vital provisions regarding minimum essential coverage as mandated by
the Affordable Care Act.
the ACA, nonexempt individuals are required to maintain minimum essential
coverage or make a shared responsibility payment. This provision is known as
the individual mandate. The ACA
specifies the categories of individuals who are eligible to receive exemptions
from the shared responsibility payment under section 5000A of the Internal
Revenue Code, which provides nonexempt individuals with a choice: maintain
minimum essential coverage for themselves and any nonexempt family members or
include an additional payment with their federal income tax return.
proposed rule sets forth standards and processes under which the health
insurance exchanges will conduct eligibility determinations for and grant
certificates of exemption from the shared responsibility payment.
proposal also provides standards for determining whether certain other types of
health insurance coverage constitute minimum essential coverage and procedures
for sponsors to follow for a plan to be identified as minimum essential
coverage under section 5000A.
it proposes to designate certain types of existing health coverage as minimum
essential coverage. Sponsors of a health plan that seek to have such coverage
recognized as minimum essential coverage would have to submit information,
including the essential health benefits
covered, to the Department of Health and Human Services (HHS). Among the
essential health benefits required in the ACA are rehabilitation and
habilitation services and devices.
proposed rule, which complements a proposed rule issued the same day by the
Internal Revenue Service, is published in today's Federal Register.
on the rule are due March 18. APTA will analyze the proposed rule to determine
if it is necessary for the association to submit comments.
provides a comprehensive summary of a recently proposed rule that has
significant importance to the new Medicaid expansion population who must be offered
essential health benefits beginning in 2014. In the proposed rule, the Centers
for Medicare and Medicaid Services recommends that states define the
habilitative services category under Medicaid and requests comments on whether
the habilitative services should be offered in parity with rehabilitative
benefits, as contemplated in previously released guidance to states on
essential health benefits. In addition, the summary outlines proposals related
to eligibility and enrollment, cost sharing, and eligibility appeals.
summary is available on APTA's Medicaid webpage.
Kick off American Heart Month by
attending the third Annual State of Women's Heart Health webinar February 5,
4:00 pm ET. This informative discussion with some of the nation's health
leaders, including Department of Health and Human Services Secretary Kathleen
Sebelius, Food and Drug Administration Commissioner Margaret Hamburg, and
Million Hearts initiative Director Janet Wright, MD, will highlight advances in
women's heart health, actions to reduce risk factors, and ways to help raise
awareness about heart disease in women.
For more information and to
register, visit the American Heart
Association's You're the Cure website.
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