NAPHS is tracking implementation of the healthcare reform law – the Patient Protection and Affordable Care Act (ACA), which was implemented as Public Laws 111-148 and 111-152.
“Doc Fix” Passed Into Law Includes Excellence in Mental Health Act, Delay of ICD-10, and More. On April 1, 2014, President Obama signed into law (P.L.113-93) a temporary, 12-month “doc fix.” The action avoids a 24% reduction in payments to physicians who treat Medicare beneficiaries that had been set to take effect March 31. The law also includes four additional provisions of note. 1) The law includes a $900 million demonstration of the Excellence in Mental Health Act – a bill NAPHS has supported – in eight states for two years to establish federally qualified community behavioral health clinics that would be eligible to participate in the Medicaid program. 2) The law includes an Assisted Outpatient Treatment Demonstration program that will provide $15 million per year from 2015 through 2018. 3) Congress is delaying enforcement of Medicare’s “two-midnight rule” for an additional six months (through March 31, 2015) and prohibiting recovery audit contractors from auditing inpatient claims spanning less than two midnights for the six-month period. 4) The law also approved a one-year delay in implementation of ICD-10 (until October 1, 2015).
NAPHS release: "Millions of Disabled and Poor Americans Encounter Discrimination When They Face Mental or Addictive Disorders, Says NAPHS; NAPHS Applauds House Oversight Hearing on Challenges Facing Families in Mental Health Crisis."
NAPHS letter submitted to House Energy and Commerce Oversight Committee hearing on “Where Have All the Patients Gone? Examining the Psychiatric Bed Shortage.”
CMS proposed rule: "Affordable Care Act; Exchange and Insurance Market Standards for 2015 and Beyond"
CMS interim final rule with comment period: "Affordable Care Act; Third Party Payment of Qualified Health Plan Premiums"
CMS final letter to insurers describing 2015 certification requirements for Qualified Health Plans in federally facilitated marketplaces or the Small Business Health Options Program
CMS final rule: "Affordable Care Act; HHS Notice of Benefit and Payment Parameters for 2015"
HHS/Treasury/Labor final rule: "Ninety-Day Waiting Period Limitation and Technical Amendments to Certain Health Coverage Requirements Under the Affordable Care Act." Also see HHS/Treasury/Labor proposed rule: "Ninety-Day Waiting Period Limitation."
IRS/Treasury final regulations: "Shared Responsibility for Employers Regarding Health Coverage"
Senate Finance Committee "Summary and Overview of Mental Health Recommendations" received in response to their 8.1.13 Open Letter seeking input on how to improve the US mental health system.
HHS interim final rule: "Patient Protection and Affordable Care Act; Maximizing January 1, 2014 Coverage Opportunities"
NAPHS statement: "NAPHS Applauds Rep. Tim Murphy for Introduction of Comprehensive Mental Health Reform Legislation; Dialogue on Tough Challenges Will Help Advance Policy Changes"
CMS/HHS final rule: "Affordable Care Act; Program Integrity: Exchange, Premium Stabilization Programs, and Market Standards; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014"
CMS proposed rule: "Basic Health Program: State Administration of Basic Health Programs; Eligibility and Enrollment in Standard Health Plans; Essential Health Benefits in Standard Health Plans; Performance Standards for Basic Health Programs; Premium and Cost Sharing for Basic Health Programs; Federal Funding Process; Trust Fund and Financial Integrity"
CMS, HHS final rule: "ACA: Program Integrity: Exchange, SHOP, and Eligibility Appeals"
Coalition for Whole Health (CWH): Toolkit for state-level advocates working on implementation and oversight of the Affordable Care Act’s (ACA’s) essential health benefits, parity, and network adequacy protections. See an overview of key issues and short guides for working with state legislatures and insurance commissioners.
CMS/HHS final rule: "ACA: Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel; Consumer Assistance Tools and Programs of an Exchange and Certified Application Counselors." Also see 7.12.13 CMS "Guidance on Certified Application Counselor Program for the Federally-Facilitated Marketplace including State Partnership Marketplaces."
CMS/HHS final rule: "Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment"
CMS/HHS final rule: "ACA: Exchange Functions: Eligibility for Exemptions; Miscellaneous Minimum Essential Coverage Provisions"
CMS/HHS proposed rule: "ACA: Program Integrity: Exchange, SHOP, Premium Stabilization Programs, and Market Standards"
Joint NAPHS / NAMI letter: Urging HHS not to apply the IMD exclusion to the Medicaid expansion population
CMS/HHS final rule: "Affordable Care Act: Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program"
HHS, Treasury, Labor final rule: "Incentives for Nondiscriminatory Wellness Programs in Group Health Plans"
CMS/HHS interim final rule: "Pre-Existing Condition Insurance Plan Program"
Proposed rule (Labor, Treasury, HHS): "90-day waiting period limitation and technical adjustments to certain health coverage requirements under the ACA"
Office of Personnel Management final rule establishing standards for the Multi-State Plan Program, which will offer at least two multi-state plans on each state insurance exchange.
HHS interim final rule: "ACA; Amendments to the HHS Notice of Benefit and Payment Parameters for 2014"
HHS final rule: "ACA: Notice of Benefit and Payment Parameters for 2014 and Amendments to the HHS Notice of Benefit and Payment Parameters for 2014; Final Rules; Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Small Business Health Options Program." Also see 11.6.13 correction.
HHS final rule on ACA "Health Insurance Market Rules; Rate Review."
HHS final rule: Standards related to essential health benefits (published in 2.25.13 Federal Register)
Mental Health Liaison Group letter in support of Mental Health First Aid Act (S.153/H.R.274)
NAPHS statement on release of essential health benefits final rule
ASPE Research Brief: "Affordable Care Act will expand mental health and substance use disorder benefits and parity protections for 62 million Americans"
CMS proposed rule: "ACA exchange functions, eligibility for exemptions, miscellaneous minimum essential coverage provisions"
IRS notice of proposed rulemaking and notice of public hearing: "Shared Responsibility Payment for Not Maintaining Minimum Essential Coverage"
IRS final regulations: Health insurance premium tax credit
NAPHS statement: "NAPHS applauds commitment by President Obama to issue final parity rules"
President Obama issues a plan to reduce gun violence and takes executive actions committing to (among other things) issuing a final parity rule, Medicaid guidance on parity, and guidance on essential health benefits and parity requirements within Affordable Care Act exchanges. Also see a letter to healthcare providers.
NAPHS letter to Vice President Biden on Newtown Task Force; NAPHS calls for a focus on coverage, access, and resources.
NAPHS comment letter on essential health benefits proposed rule
Parity Implementation Coalition comment letter on essential health benefits proposed rule.
Coalition for Whole Health (CWH) comments on essential health benefits' proposed rule
CMS: Frequently Asked Questions on Exchanges, Market Reforms and Medicaid. Also see a letter from HHS Secretary Sebelius to governors outlining additional information to help guide their work implementing the Affordable Care Act.
HHS proposed rule on ACA "Standards Related to Essential Health Benefits, Actuarial Value, and Accreditation." EHBs include "mental health and substance use disorder services, including behavioral health treatment" as one of the 10 core essential health benefits. Also see HHS fact sheet.
HHS, Treasury, Labor Dept. notice of proposed rule making on ACA "Incentives for Nondiscriminatory Wellness Programs in Group Health Plans"
NAPHS Action Alert: Tell Congress to support behavioral health as fiscal cliff solutions are discussed
HHS proposed rule: "Administrative Simplification: Adoption of a Standard for a Unique Health Plan Identifier; Addition to the National Provider Identifier Requirements; and a Change to Compliance Date for ICD-10-CM and ICD-10-PCS Medical Data Code Sets" [View]
HHS final rule (and interim final rule for some sections): "Affordable Care Act: establishment of exchanges and qualified health plans; exchange standards for employers" (also see 5.29.12 corrections)
CMS final rule (and interim final rule for some sections): "Medicaid Program: eligibility changes under the Affordable Care Act of 2010" [View]
HHS Frequently Asked Questions on essential health benefits under the Affordable Care Act [View]
NAPHS comment letter to HHS on "Essential Health Benefits Bulletin" [View]
HHS Essential Health Benefits Bulletin outlining proposal to give states flexibility in implementing essential health benefits. Comments are due 1/31/12. Also see an ASPE Research Brief on "Comparing Benefits in Small Group Products and State and Federal Employee Plans" and a fact sheet on individual market coverage.
CMS final rule on "Patient Protection & Affordable Care Act; Establishment of Consumer Operated and Oriented Plan (CO-OP) Program" [View]
CMS final rule on "Medical Loss Ratio Requirements Under the Patient Protection and Affordable Care Act." Also see interim final rule on "Medical Loss Ratio Rebate Requirements for Non-Federal Governmental Plans."
CMS/OIG interim final rule with comment period: "Medicare Program: Final Waivers in Connection with the Shared Savings Program." [View]
CMS notice: "Medicare Program; Advanced Payment Model" to test whether pre-paying a portion of future shared savings will increase participation or savings in the Medicare Shared Savings Program. Also see http://www.innovations.cms.gov/initiatives/aco/advance-payment/index.html for ongoing updates and deadlines.
NAPHS comment letter to CMS on proposed rule (with extension of comment period) on "Establishment of Exchanges and Qualified Health Plans"
FTC/DOJ final policy statement: "Statement of Antitrust Enforcement Policy Regarding ACOs Participating in the Medicare Shared Savings Program" [View]
Institute of Medicine (IOM) consensus report: Essential Health Benefits: Balancing Coverage and Cost [View]
NAPHS comment letter to CMS: Medicare Shared Savings Program: Accountable Care Organizations (ACOs) [View]
Federal Register: "Statement of Organization, Functions, and Delegations of Authority for Center for Medicare and Medicaid Innovation (FCP)" [View]
Frequently Asked Questions (Part 2) about the Affordable Care Act Implementation -- jointly issued by Departments of Labor, Treasury, & HHS [View]
Frequently Asked Questions (Part 1) about the Affordable Care Act Implementation -- jointly issued by Departments of Labor, Treasury, & HHS [View]
Congressional Research Service Report to Congress: Mental Health Parity and the Patient Protection and Affordable Care Act of 2010 [View]
HHS interim final rule: Preexisting condition insurance plan program [View]
HHS: Q&A on enrollment of children under 19 under the new policy (see 6/28/10) that prohibits pre-existing condition exclusions [View]
Departments of Health & Human Services, Labor, and Treasury issue regulation on "grandfathered" health plans under the Affordable Care Act. Also see an HHS fact sheet.
Summary of behavioral health provisions in The Patient Protection and Affordable Care Act (Public Laws 111-148, 111-152) [View]
NAPHS statement: Reform law includes provisions important to Americans facing mental and addictive disorders. Includes IMD/EMTALA demonstration on emergency psychiatric care. [View]
House passes historic healthcare reform legislation (The House first voted 219-212 on HR3590 to approve the Senate's health reform package. Then, on a 220-211 vote, the House passed a reconciliation bill, HR4872, refining the Senate healthcare reform package. The reconciliation measure now goes to the Senate for final action.)