The Centers for Medicare & Medicaid Services (CMS) has announced the final rule (CMS-2421-F2) aimed at simplifying Medicaid, Children’s Health Insurance Program (CHIP), and Basic Health Program (BHP) enrollment processes, enhancing access to affordable health coverage for millions of eligible individuals. This rule, in response to President Biden’s Executive Orders, focuses on reducing coverage disruptions, streamlining eligibility processes, and easing administrative burdens for states and applicants.
Key Highlights:
- Streamlining Application and Enrollment:
- Prohibits in-person interviews for individuals 65 or older, blind, or disabled.
- Requires states to use electronic data for income and assets verification.
- Eliminates the requirement to apply for other benefits for Medicaid eligibility.
- Allows states to use projected predictable medical expenses for financial eligibility determination.
- Helping People Enroll and Stay Enrolled:
- Requires renewals no more than once every 12 months for certain groups.
- Provides prepopulated renewal forms and a 90-day reconsideration period.
- Requires states to update addresses and accept renewals through various methods.
- Removing Barriers to Children’s Coverage:
- Allows CHIP beneficiaries to re-enroll without a lock-out period.
- Prohibits waiting periods and annual/lifetime limits on benefits in CHIP.
- Establishes a specific pathway to eligibility for children with disabilities in Medicaid.
- Enhancing Integrity of Medicaid and CHIP:
- Updates record keeping regulations for state agencies to enhance oversight.
- Defines eligibility documentation requirements and mandates electronic record storage.
- Sets minimum standards for timely eligibility determinations and documentation retention.
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CMS issued a final rule with the Physician Fee Schedule that took effect January 1, 2024. Many new Health-Related Social Needs billing codes were introduced, many which will be very applicable in the palliative care setting. They include:
- Caregiver Training Services
- Social Determinants of Health (SDOH) Risk Assessment
- Community Health Integration
- Principal Illness Navigation
- Principal Illness Navigation-Peer Support
To help address many of the questions that these new billing codes have drawn, CMS has put out a Frequently Asked Questions (FAQ)Â for providers, programs and billers to reference. This detailed FAQ will address questions like, who can bill, types of services, definitions and many other questions related to the new billing codes.
