On January 14, 2013, the Department of Health and Human Services (HHS) released a proposed rule implementing key Affordable Care Act provisions relating to Medicaid and the Exchanges. This proposed rule codifies statutory eligibility provisions, lays out a structure and options for coordinating Medicaid, the Children’s Health Insurance Program (CHIP), and Exchange eligibility notices and appeals. It also proposes to modify existing benchmark benefits regulations for low-income adults, and codify several of the provisions included in the Children’s Health Insurance Program Reauthorization Act (CHIPRA).

This proposed rule includes information on how consumers will receive coordinated communications on eligibility determinations and can appeal eligibility determinations. It gives states flexibility in designing benefits and determining cost sharing in the Medicaid program. The proposed rule also provides flexibility to state-based Exchanges by allowing them to opt to rely on HHS for verifying whether an individual has employer-sponsored coverage and conducting some types of appeals.

The NPRM is available on display at the Federal Register here: www.ofr.gov/OFRUpload/OFRData/2013-00659_PI.pdf

A fact sheet with additional information regarding the changes made through this proposed rule will be available on Medicaid.gov and http://cciio.cms.gov later today.

Please direct questions to This email address is being protected from spambots. You need JavaScript enabled to view it..

On August 21, 2012 the U.S. Department of Education forwarded the final version of the proposed changes to the parental consent to access Medicaid regulation, 34 CFR § 300.154(d)(iv)(A) to the Office of Management and Budget (OMB).

USDOE requested OMB to complete an expedited 45 day review period. If OMB is able to honor this request, the Final Rule should be released just prior to the NAME 2012 Annual Conference which is being held in Providence, RI October 9-12, 2012.

NAME is inviting to the Annual Conference a representative from the Office of Special Education and Rehabilitative Services (OSERS) to provide an update to this and other issues.

On May 14, 2012, the U.S. Department of Education released the Retrospective Review Plan Report. This was a summary of various regulations in regards to effectiveness, benefits and cost. The report included the proposed changes to the parental consent to access Medicaid regulation, 34 CFR § 300.154(d)(iv)(A). The report indicated that the proposed regulation would result in a savings of $14,144,000 to $41,423,000 annually. The report also indicated that they anticipate issuing the final regulation by July or August of 2012. To read this ten page report click here.

The Centers for Medicare & Medicaid Services (CMS) is hosting six Payment Error Rate Measurement (PERM) Provider Education Webinars/Conference Calls to assist PERM Cycle 1** Medicaid-enrolled providers prepare for these unique federal audits. The six sessions are identical in content, but you may want to listen in on more to hear the different questions and answers. The calls are designed to provide an opportunity for Medicaid and Children’s Health Insurance Program (CHIP) providers to enhance your understanding of your specific responsibilities so you are prepared before and during PERM audits.

The PERM program is designed to measure improper payments in the Medicaid and CHIP programs, as required by the Improper Payments Information Act (IPIA) of 2002 (amended in 2010 by the Improper Payments Elimination and Recovery Act or IPERA).

The dates of the calls in 2012 are May 23, June 21, July 24, August 23, September 25, and October 24. Each occurs 2-3 pm EST.

For more details and to register for one or more webinars/conference calls, click here then go to the “provider education webinar/conference schedule download” link: www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/PERM/Provider_Education_Calls.html

**PERM cycle 1 states are: Arkansas, Connecticut, Delaware, Idaho, Illinois, Kansas, Michigan, Minnesota, Missouri, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Virginia, Wisconsin, Wyoming)

NAME’s colleague from the Minnesota Medicaid Agency, Christina Baltes, who is the Manager for her state’s Medicaid payment Error Rate Measurement, has offered to answer your questions about PERM audits. She said, “I want to be able to assist school districts as much as possible ahead of a PERM audit, rather than see them face an error”. Contact her at: This email address is being protected from spambots. You need JavaScript enabled to view it.

The Trust for America's Health, supported by the Robert Wood Johnson Foundation, released a report in March 2012, "Investing in America's Health, A State By State Look at Public Health Funding and Key Health Facts"

Their premise is, "investing in disease prevention is the most effective, common-sense way to improve health. It can help spare millions of Americans from developing preventable illnesses, reduce health care costs, and improve the productivity of the American workforce so we can be competitive with the rest of the world. Tens of millions of Americans are currently suffering from preventable diseases such as cancer, heart disease, and diabetes. And, today's children are in danger of becoming the first generation in American history to live shorter, less healthy lives than their parents."

To see and share the full 48-page report, click here: Investing in America's Health

On February 9, 2012 John Hill, NAME Governmental Affairs Committee Chair met with Jennifer Sheehy and Mary Louise Dirrigl from the Office of Special Education and Rehabilitation Services to discuss the status of the proposed changes to 34 CFR §300.154(d)(2)(iv). The proposed regulation was published in the Federal Register on September 28, 2011. The public comment period closed on December 12, 2011. The proposed regulation can be reviewed at: www.gpo.gov/fdsys/pkg/FR-2011-09-28/pdf/2011-22784.pdf.

To view all of the public comments submitted go to: www.regulations.gov.

  • Click on "Read Comments";
  • Select "Proposed Rule" in the Select Document drop down;
  • Enter Key Word "ED-2011-OSERS-0012";
  • Click "Search";
  • Under "Actions" click on "Open Docket Folder"; then,
  • Under "Document Type" mark "Public Submission".

Jennifer Sheehy and Mary Louise Dirrigl indicated that OSERS has completed its review of the comments, and is currently drafting the final rule. The draft final rule will be reviewed within the Department, and then forwarded to the Office of Management and Budget (OMB) for a 90 day review period. After approval by OMB, the Final Regulation will then be published in the Federal Register.

While Jennifer and Mary Louise could not give an estimated date on how long the process will take, they did indicate it is one of the Department’s priorities.

The comment period closed on December 12, 2011. The Office of Special Education and Rehabilitative Services (OSERS) is in the process of reviewing and preparing responses to the public comments. Continue to monitor the NAME home page for updates.

NAME greatly appreciates the efforts by OSERS to address the financial and administrative burdens the current IDEA Parental Consent to access Medicaid regulation has created for LEAs while protecting and assuring the parents rights.

The NAME organization fully supports the changes that are outlined in the proposed regulation and encourages everyone who has been impacted by the current regulation to submit written comments.

The following document provides an overview of the proposed regulation, a link to the proposed regulation and instructions on how to submit official comments on the proposed regulation:

Four year historical review/timelines of the meetings and events NAME has had with OSERS/OSEP regarding the current Medicaid parental consent regulation:

The following are template letters for those interested for submitting official comments regarding the proposed regulation:

On September 28, 2011, the Office of Special Education and Rehabilitative Services posted a proposed regulation in the Federal Register that will change the IDEA regulation requiring schools to obtain parental consent prior to billing Medicaid for health-related IEP services. The proposed regulation can be found at: www.gpo.gov/fdsys/pkg/FR-2011-09-28/pdf/2011-22784.pdf

OSEP responded to question from NAME - Does 34 CFR 300.154(a)(1)34 CFR §300.154(a)(1) “The financial responsibility of each noneducational public agency described in paragraph (b) of this section, including the State Medicaid agency and other public insurers of children with disabilities must precede the financial responsibility of the LEA (or the State agency responsible for developing the child's IEP)”require an LEA to claim for Medicaid reimbursement? Link to OSEP response.