HHS Unveils Proposed HIE Rules

John Commins, for HealthLeaders Media , January 15, 2013

Federal officials on Monday rolled out a table-rattling 474-page proposed rule designed to clarify and promote consistency around eligibility, benefits, and appeals for people enrolling in health insurance exchanges in 2014, and to provide more flexibility for states' Medicaid programs. 

"Today, we are proposing a rule to provide Americans with access to affordable, high quality health coverage and give states more flexibility to implement the law in a way that works for them," Health and Human Services Secretary Kathleen Sebelius said in a media release.

On Jan. 1, 2014 the Affordable Care Act expands Medicaid coverage to include adults who earn up to 133% of poverty—$14,865 for an individual or $30,656 for a family of four, while other people looking for coverage will be able to buy it through a health insurance exchange. HHS said the rules proposed Monday will make it easier for consumers to learn if they're eligible for Medicaid or tax credits. 

The proposed rule includes information on how consumers will receive communications on eligibility determinations and how they can appeal eligibility denials.  It also gives states flexibility in designing benefits and determining cost sharing in the Medicaid program.

Under the proposal, state-based exchanges may choose to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals, HHS said.

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