Overview of the July 5, 2013 Final Rule on Medicaid and the Children’s Health Insurance Program: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearings and Appeal Processes, and Premiums and Cost Sharing; Exchange Eligibility and Enrollment

Abstract

Since the enactment of the Affordable Care Act in 2010, there has been consistent federal guidance employing and clarifying its provisions. Hilltop develops regulation summaries to assist state and local policymakers in their implementation of health reform. On July 5, 2013, the U.S. Department of Health and Human Services (HHS) issued a final rule on Medicaid and Children’s Health Insurance Programs (CHIPs): essential health benefits (EHBs) in alternative benefit plans, eligibility notices, fair hearings and appeals processes, and premiums and cost sharing; Exchanges: eligibility and enrollment. This rule finalizes many of the provisions of the Notice of Proposed Rule making (NPRM) released on January 22, 2013. This document provides a high-level summary of this rule and highlights key changes to the regulation since the issue of the proposed rule.