Did You Know This About Medicaid?

Federally Facilitated Exchange (FFE) Fact Sheet

The Centers for Medicare and Medicaid Services (CMS) is working to build new health insurance marketplaces called Exchanges.  Consumers and small businesses in every state (including the District of Columbia) will have access to a marketplace.  All Exchanges will launch open enrollment in October 2013.  Please click on the following link to read the latest FFE Fact Sheet: http://cciio.cms.gov/resources/files/Files2/FFE Progress fact sheet.pdf

Proposed Rule: Notice of Benefit and Payment Parameters (CMS-9964-P)

This proposed rule would establish parameters for several programs including reinsurance, risk corridors, and risk adjustment (the "3 R's") and would provide additional regulatory guidance, such as adjustments to the MLR calculation.

Paper and Materials

• Fact sheet (posted on cciio.cms.gov and CMS newsroom)

• Internal Q&A (available upon request)  

Additionally, for your information:  Today the Office of Personnel Management published a Notice of Proposed Rulemaking to implement the Multi-State Plan Program (MSPP) pursuant to section 1334 of the Affordable Care Act.  Additional information may be found here: http://www.opm.gov/insure/mspp/index.asp

Administration Releases Rules Pertaining to the Health Insurance Market Reforms, Essential Health Benefits and Employment-based Wellness Programs

Today, the Obama Administration issued proposed rules to implement Affordable Care Act provisions that would make it illegal for insurance companies to discriminate against people with pre-existing conditions, and make it easier for consumers to compare health plans and employers to promote and encourage employee wellness.

The proposed rules include:

• “Market Rules” that would prohibit health insurance companies from discriminating against individuals because of a pre-existing or chronic condition, beginning in 2014.  Under this rule, insurance companies would be allowed to vary premiums within limits, only based on age, tobacco use, family size, and geography.  In addition, health insurance companies would be prohibited from denying coverage to any American because of a pre-existing condition or from charging higher premiums to certain enrollees because of their current or past health problems, gender, occupation, and small employer size or industry.  The rule also would ensure that young adults and people for whom coverage would otherwise be unaffordable have access to a catastrophic plan in the individual market.  For more information regarding this rule, visit http://www.ofr.gov/OFRUpload/OFRData/2012-28428_PI.pdf.

• “Essential Health Benefits”, outlining policies and standards for coverage of essential health benefits, while giving states more flexibility to implement the Affordable Care Act.  Essential health benefits are a core set of benefits that would give consumers a consistent way to compare health plans in the individual and small group markets. A companion letter on the flexibility in implementing the essential health benefits in Medicaid was also sent to states.  For more information regarding this rule, visit http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf.

• “Wellness”,  implementing and expanding employment-based wellness programs to promote health and help control health care spending, while also ensuring that individuals are protected from unfair underwriting practices that could otherwise reduce benefits based on health status.  

To view the proposed rule on Health Insurance Market Reforms, visit: http://www.ofr.gov/OFRUpload/OFRData/2012-28428_PI.pdf

To view the proposed rule on Essential Health Benefits, visit: http://www.ofr.gov/OFRUpload/OFRData/2012-28362_PI.pdf

To view the letter to State Medicaid Directors, visit: http://www.medicaid.gov/Federal-Policy-Guidance/Federal-Policy-Guidance.html

If you have any questions, please contact the CMS Office of Legislation.  Thank you.

HHS Announces Medicare Premium, Deductibles, and Coinsurance Amounts for 2013

The U.S. Department of Health and Human Services (HHS) today announced the Medicare Part A and Part B premiums, deductibles and coinsurance amounts for 2013.   

The Medicare Part B standard premium in 2013 will be $104.90, a slight increase over last year’s premium of $99.90, and the Part B deductible will be $147.  Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items.  

HHS also announced a decrease in Medicare Part A monthly premiums as well as modest increases in the Part A deductible.  Monthly premiums for Medicare Part A, which pays for inpatient hospitals, skilled nursing facilities, and some home health care, are paid by about 1 percent of beneficiaries who do not automatically qualify for Medicare.

• Medicare Part A monthly premiums will be $441 for 2013, a decrease of $10 from 2012.

• The Part A deductible paid by beneficiaries when admitted as a hospital inpatient will be $1,184 in 2013, an increase of $28 from last year's deductible of $1,156.

The Federal Register posting can be found at: www.ofr.gov/inspection.aspx

If you have any questions, please contact the CMS Office of Legislation.  Thank you.

Starting October 15, 2012: Medicare Open Enrollment Begins

The Centers for Medicare and Medicaid Services (CMS) announced today that people with Medicare have more high quality choices and the performance of Medicare Advantage plans is improving.  CMS also released the 2013 quality ratings for Medicare health and drug plans on the web-based Medicare Plan Finder.  Beginning today, and throughout the Open Enrollment Period, people with Medicare can use the star ratings to compare the quality of health and drug plan options and select the plans that are the best value based on their needs in 2013. 

In 2013:

  • People with Medicare will have access to 127 four- or five-star Medicare Advantage plans.  These plans currently serve 37 percent of Medicare Advantage enrollees, and may attract more with their improved quality ratings. In 2012, people with Medicare had access to 106 four or five star plans, which served only 28 percent of enrollees.
  • People with Medicare will have access to 26 four or five star prescription drug plans, which currently serve 18 percent of enrollees.  This is an improvement from 2012, in which 13 four or five star plans are serving only 9 percent of enrollees.

Medicare plans are given an overall rating on a 1 to 5 star scale, with 1 star representing poor performance and 5 stars representing excellent performance. Users of the Plan Finder will also see a gold star icon designating the top rated 5-star plans, and a different icon for those plans who are consistently poor performers. 

At the same time that quality is improving and benefits are increasing, premiums in the Medicare Advantage program are remaining steady. Since the Affordable Care Act was passed in 2010 through 2013, Medicare Advantage premiums have fallen by 10 percent and enrollment is increasing by 28 percent.  The average estimated basic Medicare prescription drug plan (PDP) premium is projected to hold steady from last year, at $30 for 2013. 

Medicare Open Enrollment runs from October 15th through December 7th. For more information about Open Enrollment, please visit:


A press release on today’s announcement will be available at: http://www.hhs.gov/news

For a fact sheet and details about the 2013 Part C and D Plan Quality Ratings released today, please visit:


If you have any questions, please contact the CMS Office of Legislation.  Thank you.

Ground-breaking public-private partnership to prevent health care fraud

New tools to fight fraud, strengthen federal and private health programs, and protect consumer and taxpayer dollars... Read more

Updated and enhanced tools for patients to compare hospitals and nursing homes

Two websites that help Americans make informed choices about hospitals and nursing homes have been redesigned and will make more information available to the public. Read more

Newly launched Marketplace Outreach and Education page

Starting in 2014, there will be a new way for people to buy health insurance. As you know, the Affordable Care Act created unprecedented opportunities for millions of Americans to access health insurance. This includes establishing the Health Insurance Marketplace, sometimes called “Exchanges.” To help facilitate a better understanding of the marketplace a new page was created on cms.gov.  Read more

Message from CMCS: Medicaid.gov gets summer update 

The Center for Medicaid and CHIP Services is pleased to announce a refresh of Medicaid.gov.  We have been encouraged by the positive feedback about the site we have gotten since its launch in December 2011. The improvements we are rolling out this summer are based on data regarding the site’s usage to date, as well as user surveys.

Here are some of our initial changes:

  • The front page has been reorganized to make it easier for visitors to find the information they are looking for, and to highlight topics of special interest
  • We have added the “New and Notable” section on the front page, increasing our ability to showcase the latest information from CMCS  
  • We have added a new data and technology page to feature all the work underway to help states and others in getting IT systems ready for 2014
  • We have added a “CHIP” tab at the top of the front page that enables easy navigation to newly organized information on the CHIP program
  • The state profiles section continues to be prominently featured, and we will continue to make the information we display about each state’s Medicaid program more robust

We hope these enhancements make the site even more useful for stakeholders and we welcome your ongoing feedback.

CMS has a new look! 

This new visual identity mark logo represents CMS in motion - moving forward, expanding to help new and different groups of people get access to health care. Keep an eye out for our newest logo whenever receiving documents from us. We’re always moving forward in our endless pursuit to better serve the American people.


 OCR’s HIPAA Privacy, Security and Breach Notification Audit Program & Protocol

OCR posted on its website the protocol used to conduct the audits required by the HITECH Act.  The OCR HIPAA Audit program analyzes key processes, controls, and policies of selected covered entities pursuant to the HITECH Act audit requirement.  OCR established a comprehensive audit protocol that contains the requirements to be assessed through these performance audits. The entire audit protocol is organized around modules, representing separate elements of privacy, security, and breach notification.  The combination of these multiple requirements may vary based on the type of covered entity selected for review.

  • The audit protocol covers Privacy Rule requirements for (1) notice of privacy practices for PHI, (2) rights to request privacy protection for PHI, (3) access of individuals to PHI, (4) administrative requirements, (5) uses and disclosures of PHI, (6) amendment of PHI, and (7) accounting of disclosures.
  • The protocol covers Security Rule requirements for administrative, physical, and technical safeguards.
  • The protocol covers requirements for the Breach Notification Rule.

Learn more about the OCR HIPAA Audit Program and access the audit protocol.