NCSL’s Federal Health Reform State Legislative Tracking Database
Many major provisions of PPACA will go into effect on Jan. 1, 2014, making 2013 a year of important policy changes, transitions and implementation. NCSL will continue tracking legislative efforts to address the federal law in its tracking database. You can search 2011, 2012 and 2013 legislation by state, topic, keyword, status, and primary sponsor. The topics include: Access to Primary Care; Authorizing/Planning and Funding; Challenges and Alternatives; Essential Health Benefits; Health Centers; Health Information Technology; Health Insurance Exchanges; Health Insurance Reform; Medicaid and CHIP; Other; Prevention and Wellness; and Providers and Workforce.
Individual Mandate Requirements Spelled Out
The PPACA's "individual mandate” requires most American taxpayers to have health coverage beginning in 2014. On Jan. 30, the Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) proposed regulations to address the details, such as who qualifies for an exemption and who pays a penalty. The CMS and IRS proposed rules outline nine categories of individuals who are either entirely exempt from the requirement to maintain minimum essential coverage or who are exempt from the associated tax penalty. For example, taxpayers who cannot find affordable coverage or who spend less than three consecutive months without coverage will not have to pay a penalty. Other categories of exemption include taxpayers with incomes below the filing threshold; Indian tribe members; individuals who have suffered a "hardship" or whose refusal is based on "religious conscience;" prisoners; members of a health care sharing ministry; immigrants who are not lawfully present in the U.S. and individuals who would be eligible for the PPACA-related Medicaid expansion but live in a state that chooses not to expand Medicaid eligibility.
The Congressional Budget Office estimated that less than 2 percent of the public would owe the tax penalty, set at $95 for 2014, and increasing to $695 by 2016. A Congressional Research Service report and the HHS Fact Sheet provides background and more information.
Federal Agencies Answer More PPACA Questions
This week, the Centers for Medicare and Medicaid Services released another set of questions and answers related to Medicaid and the Affordable Care Act. The topics addressed include the basic health program, determining who will qualify for the enhanced Federal Medical Assistance Percentages (FMAP), “expansion state” FMAPs, coverage for pregnant women and children and the transition to modified adjusted gross income.
In the last month, the U.S. Department of Health and Human Services and other federal agencies released a number of proposed rules, guidance and frequently asked questions related to the implementation of PPACA, some of which are featured in this newsletter. Others include:
NCSL Health Reform/Medicaid Webinars Archive Now Available
NCSL’s Top Issues webinars highlight the most important policy issues for state legislatures. This year, Medicaid and federal health reform implementation were at the top of the list.
On Feb. 1, NCSL health policy staff briefed legislators and legislative staff on the optional PPACA Medicaid expansion, policy options to tame costs and preventing Medicaid fraud and abuse. The expansion is not the only Medicaid-related issue states are grappling with this session. Since Medicaid is a significant source of coverage and a major payer of health care services in most states, policymakers are looking at ways to improve the value of Medicaid. The webinar discussed strategies including increased use of managed care, expanding home and community-based care options for long term care, and reducing fraud, waste and abuse.
The Feb. 4 webinar focused on health reform. With provisions of PPACA moving forward, states face fast-approaching deadlines. Millions of people are expected to start enrolling in health insurance exchanges by the end of this year. NCSL’s health policy experts discussed navigating the federal law's pressing deadlines, requirements and state implementation activities.
An archive recording and the PowerPoint presentations of both webinars are available at the links below.
The recordings are free to NCSL members and $39 for all others.
Oral Health and Prevention
The PPACA contains numerous provisions that promote prevention in health care, including dental health. The law requires most insurance plans to cover certain preventive pediatric oral health services. Among the specific services to be covered with no out-of-pocket costs are oral health risk assessments for children and fluoride supplements for children whose water source does not contain fluoride. Millions of additional children could gain dental coverage by 2014 as a result of the individual mandate, including access to preventive dental services, such as dental sealants.
The law established the Prevention and Public Health Fund, and states may use allocations from the fund to monitor oral health conditions better and to improve community and clinical prevention, among other options. For more information regarding state actions related to dental sealants for children, consult a new Pew Children’s Dental Campaign report Falling Short: Most States Lag on Dental Sealants. For additional information please visit NCSL’s Children’s Oral Health webpage.
NCSL’s Scope of Practice Legislative Tracking Database
Health care professionals can treat, diagnose and prescribe according to their defined scope of practice (SOP), which differs from state to state, and is defined by state legislatures and regulatory boards. So far in 2013, 34 scope-of-practice bills have been proposed in 18 states. Since January 2011, a total of 2,323 scope-of-practice bills were proposed in 53 states, territories, or D.C. For updated information, visit the Scope of Practice Legislative Tracking Database.
New Privacy Rules Apply to PPACA
On Jan. 17, U.S. Health and Human Services’ Office for Civil Rights released its long-awaited final regulations expanding privacy rights for patients and others. These new rules trigger major changes in privacy measures required of health providers by two federal laws, the Health Insurance Portability and Accountability Act (HIPAA, 1996) and the Health Information Technology for Economic and Clinical Health Act (HITECH, 2009).
Although not written specifically for the PPACA, these rules will apply to virtually all people insured or treated, including those newly covered through exchanges, private employer coverage, and Medicaid expansions. “This final omnibus rule marks the most sweeping changes to the HIPAA Privacy and Security Rules since they were first implemented,” said Leon Rodriguez, HHS Office for Civil Rights Director.
The final regulations, published Jan. 25, spell out the new HIPAA compliance obligations of business associates and — for the first time — directly regulate thousands of subcontractors.” Among many things, the rule also prohibits health plans from using genetic information for underwriting (as called for under the Genetic Information Nondiscrimination Act of 2008) and adds new privacy restrictions on health-related businesses engaged in marketing and fundraising. One of the highlights of the new rules is the creation of a clear process to determine when patients must be notified of a breach in their medical record privacy.