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  • HHS Proposes Standards for Minimum Essential Coverage

    A proposed rule issued Wednesday includes vital provisions regarding minimum essential coverage as mandated by the Affordable Care Act.

    Under 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.

    This 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.

    The 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.

    Additionally, 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.

    This proposed rule, which complements a proposed rule issued the same day by the Internal Revenue Service, is published in today's Federal Register.

    Comments 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.  

    New Summary: Proposals Affecting Medicaid and CHIP Beneficiaries

    APTA 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.

    The summary is available on APTA's Medicaid webpage.  

    Sign Up for February 5 Women's Heart Health Webinar

    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.