In the first edition of 2023, we provide updates on two key Medicaid policy developments from the end of last year.
The last days of 2022 included the passage of the Consolidated Appropriations Act of 2023 (Omnibus Act), which includes a phased-in approach to ending the almost three-year moratorium on eligibility redeterminations for Medicaid enrollees. This month’s edition includes a short piece focused on reporting requirements and provisions in the Omnibus Act to ensure accurate eligibility redeterminations as that process restarts.
Also, this edition includes a summary of the Centers for Medicare and Medicaid Services proposed rule aimed at easing communications between healthcare providers and insurance carriers about patient care needs.
We hope our readers had a restful new year, and as always, stay tuned to Health Policy News for insights as the health policy priorities of 2023 unfold.
Unwinding the Continuous Enrollment Requirement
Although the Public Health Emergency (PHE) end has not been formally announced, the administration has taken steps to start the process of unwinding the continuous coverage requirement. The Consolidated Appropriations Act of 2023 (Omnibus Act) was signed into law on December 29, 2022, and includes a pathway to unwinding the Continuous Coverage Requirement (CCR) that has been in effect since January 2020. Medicaid Departments are faced with an unprecedented undertaking to prevent coverage loss or gaps as they undergo the process of working though eligibility for over 90 million Medicaid enrollees over the next 12 plus months.
To read more about the end of the CCR, and the steps states will have to take under the Omnibus Act to ensure accurate redeterminations occur, click here.
CMS Seeks to Support Communications between Providers and Carriers
In December 2022, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule aimed at improving administrative simplification related to healthcare providers sharing HIPPA-protected information with insurance carriers. Healthcare providers are frequently required to submit supplemental documentation to assist carriers in determining whether a service is covered and/or medically necessary, and for other reasons, such as substantiating health care claims and prior authorizations. The rule proposes changes that would ease administrative burdens by simplifying the process providers use for providing carriers with supplemental information about patients and their courses of treatment.
To read more about the proposed rule, click here.
