Polk County Advanced Practice Nurses Association
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AANP Legislatove Update

Posted over 5 years ago by Michelle Rampersad

April 1, 2013

HHS: Private Coverage Options Must Meet Medicaid Requirements

Guidance from the Department of Health and Human Services may impact some states' efforts to expand Medicaid coverage by enrolling low-income residents in private health plans. “Under all these arrangements, beneficiaries remain Medicaid beneficiaries and continue to be entitled to all benefits and cost-sharing protections,” the agency stated in guidance released March 29. “States must have mechanisms in place to wrap-around private coverage to the extent that benefits are less and cost sharing requirements are greater than those in Medicaid,” according to the guidance.

The agency left open the prospect that Secretary Sebelius could consider approving premium assistance demonstrations to guide the 2017 State Innovation Waivers. The guidance also suggested that HHS would only consider arrangements that offer patients at least two choices of health plans and provide wrap-around benefits and support for premiums. Nurse practitioners are seen as crucial to meeting the demand for primary care services that will be significantly increased by expansion of Medicaid eligibility.

The Centers for Medicare and Medicaid Services (CMS) also released final regulations March 29 reaffirming that the federal government will pay 100 percent of the cost of newly eligible beneficiaries under Medicaid expansion until 2016. After 2016, the federal government will begin phasing down to the permanent match rate of 90 percent by 2020. The rule clarified that a state that expanded Medicaid coverage to low-income adults before the Affordable Care Act became law can still get the 100 percent federal match rate for newly eligible adults. States can also receive an expansion state Federal Medical Assistance Percentage (FMAP) for childless adults the state already covers who do not qualify as newly eligible.

CMS Urges Providers to Prepare for ICD-10 Transition

The Centers for Medicare and Medicaid Services (CMS) has set October 1, 2014 for implementation of the comprehensive ICD-10 coding sets. Nurse practitioners and other providers will be required to use these codes to report medical diagnoses and inpatient procedures. Health care providers have raised concerns that CMS hasn’t fully prepared providers for the changeover.

AANP was one of several groups invited by CMS to participate in a March 27 session. During the session, CMS discussed the current status of implementation and resources for putting ICD-10 in place to include checklists for all practitioners. The agency continues pressing toward the October deadline and is looking to better align the new system with electronic health systems, privacy and portability requirements. Providers expressed concern that timelines and checklists developed for small, medium and solo practices will be of little help. AANP will work with CMS on providing information and guidance tailored to meet the needs of nurse practitioners.

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