Templates & Toolkits | Feb 28, 2014

Series: Consumer Assistance Resource Guides

Manatt Health Solutions and the Center for Health Care Strategies 

Early evidence from across the nation suggests that consumer assisters are playing a vital role in helping people enroll in the new coverage options made possible by the Affordable Care Act. The State Health Reform Assistance Network has engaged with a number of states to develop easy to understand materials to educate consumer assisters about various issues that may confuse consumers and the assisters trying to help them during the eligibility determination and enrollment process. The following resource guides, prepared by Manatt Health Solutions and the Center for Health Care Strategies, were developed to help consumer assisters answer some of the most common eligibility and enrollment questions:

– Minimum Essential Coverage

– Household Composition Eligibility Rules

– MAGI Household Income Eligibility Rules

– Immigrant Eligibility

– American Indians and Alaska Natives

 

 

Expert Perspectives

January 14, 2022

New Requirements to Cover Over-the-Counter COVID Tests: Implications for State Insurance Regulators

On January 15, 2022, health insurers will be subject to new federal requirements to cover and waive cost-sharing for over-the-counter diagnostic tests for COVID-19 for the duration of the federal public health emergency. Past federal guidance required insurers to fully cover COVID-19 tests, but allowed them to require enrollees to first obtain a health professional’s determination that a test is medically necessary. The new requirements, published January 10, enable consumers to obtain the tests directly from pharmacies or online retailers without being seen by a health professional. With case rates surging and the costs of over-the-counter COVID-19 tests ranging from $14 to $34, this new benefit should provide significant financial relief to privately insured individuals. This expert perspective focuses on key provisions of the new coverage requirements as well as health equity considerations and implications for state insurance regulators.

New CMS Guidance on Community-Based Mobile Crisis Services

On December 28, 2021, the Centers for Medicare & Medicaid Services (CMS) released a State Health Official letter providing guidance on the scope of and enhanced payments for qualifying community-based mobile crisis intervention services for Medicaid enrollees experiencing a mental health or substance use disorder crisis. The CMS guidance comes as the United States is grappling with staggering need for mental health and SUD services that has grown as a result of the COVID-19 pandemic. This expert perspective provides an overview of the new guidance and reviews the requirements for community mobile crisis services.

 

January 7, 2022

The Proposed 2023 Notice of Benefit & Payment Parameters: Implications for States

On December 28, 2021, the Centers for Medicare & Medicaid Services released its proposed Notice of Benefit & Payment Parameters for plan year 2023. This annual regulation governs core provisions of the Affordable Care Act, including operation of the health insurance marketplaces, standards for insurers, and the risk adjustment program. This expert perspective focuses on provisions of the proposed rule that are of particular import to the state-based marketplaces and state insurance regulators.