The Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid One Ashburton Place Boston, MA 02108

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The Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid One Ashburton Place Boston, MA 02108 DEVAL 1,. PATRICK Governor,JOHN w.

1 The Commonwealth of Massachusetts Executive Office of Health and Human Services Office of Medicaid One Ashburton Place Boston, MA DEVAL 1,. PATRICK Governor,JOHN w. POLANOW1CZ Secretary KRISTIN L. THORN Medicaid Director f CC <f_t: NOTICE OF PUBLIC HEARING: Proposed MassHealth and Health Safety N~, Regulations about the Affordable Care Act Pursuant to the authority of M.G.L. c. 6A, s. 16 and in accordance with M.G.L. c. 30A, s. 2, a public hearing will be held on Monday, December 2, 2013, at 10 a.m. in the Worcester Public Library (Main), 3 Salem Square, Worcester, MA 01608, , relative to the adoption of: 101 CMR : Health Safety Net Eligible Services, CMR 13.00: Health Safety Net Eligible Services (repeal), 130 CMR : MassHealth: General Policies, 130 CMR : MassHealth: Request for Benefits, 130 CMR : MassHealth: Universal Eligibility Requirements, 130 CMR : MassHealth: Citizenship and Immigration, 130 CMR : MassHealth: Coverage Types, 130 CMR : MassHealth: Financial Requirements, 130 CMR : MassHealth: Other Related Benefits, 130 CMR : MassHealth: Managed Care Requirements, 130 CMR : MassHealth: General Policies, 130 CMR : MassHealth: Eligibility Process, 130 CMR : MassHealth: Universal Eligibility Requirements, 130 CMR : MassHealth: Citizenship and Immigration, 130 CMR : MassHealth: Coverage Types, 130 CMR : MassHealth: Financial Eligibility, 130 CMR : MassHealth: Related Program Benefits, 130 CMR : MassHealth: Other Division Programs, 130 CMR : Independent Clinical Laboratory Services, 130 CMR : Home Health Agency Services, 130 CMR : Community Health Center Services, 130 CMR : Pharmacy Services, 130 CMR : Acute Outpatient Hospital Services, 130 CMR : Acute Inpatient Hospital Services, 130 CMR : Family Planning Agency Services, 130 CMR : Freestanding Ambulatory Surgical Center Services, 130 CMR : Podiatrist Services, 130 CMR : Independent Diagnostic Testing Services, 130 CMR : Physician Services, 130 CMR : Administrative and Billing Regulations, 130 CMR : Insurance Partnership. The proposed changes to MassHealth and Health Safety Net regulations are intended to conform with the changes to eligibility, benefits, and operational processes that will be implemented in accordance with the Affordable Care Act (ACA) and consistent with the Commonwealth's plans for implementation of the federal Affordable Care Act and related regulations at 42 CFR 433, 435, 440, 447,457, changes to M.G.L. c. 118E as amended by Chapter 118 of the Acts of 2012 and Chapter 35 of the Acts of 2013, the terms of MassHealth's 1115 Demonstration Projects, and Section 266 of Chapter 224 (State Cost Containment legislation). Specifically, the regulation changes implement the categorical and financial requirements for MassHealth programs authorized by the ACA and changes in Massachusetts state law. In addition, the proposed regulations describe operational changes in the application and redetermination processes.

2 The proposed regulation is planned to go into effect no sooner than January 1, There is no fiscal impact on cities and towns. Interested parties are encouraged to submit comments on these proposed regulations. All persons desiring to be heard on this matter are hereby notified to appear at the designated time and place. Persons who notify EOHHS that they intend to speak will be afforded an early opportunity to testify if EOHHS receives notice by 5:00 P.M. on November 26,2013. Contact us by telephone at or by fax at If you do not provide EOHHS with advance notice of your desire to speak, you will still be given an opportunity to do so if you appear at the hearing. Written comments will be accepted up until 5:00 p.m. on December 3, 2013, and may be sent to the Executive Office of Health and Human Services, Office of Medicaid, One Ashburton Place, Room 1109, Boston, MA 02108, or ed to ed comments should contain the sender's name, mailing address, and organization or affiliation, if any. Comments and testimony provided in response to the public hearing on November 4th will be considered along with any additional comments and testimony received in response to the public hearing scheduled for December 2, The regulations proposed at the November 4th public hearing are the same regulations to be proposed at the December 2 nd public hearing. There have been no changes in the interim. All persons desiring to review the current draft of the proposed actions may go to or request a copy in writing or in person from MassHealth Publications, 100 Hancock Street, 6th Floor, Quincy, MA MassHealth may adopt a revised version of the proposed actions taking into account relevant comments and any other practical alternatives that come to its attention. Monday, November11,2013

3 SMALL BUSINESS IMPACT STATEMENT In order to accurately predict the impact the adoption, amendment, or repeal of a regulation will have on small businesses, the promulgating authority must conduct a thorough analysis that not only considers the potential effects of the action but also quantifies the costs, if any, associated with each. The questions below are designed to aid promulgating authorities in conducting their analysis. Agency Submitting Regulation: Executive Office of Health and Human Services: Division of Medical Assistance (MassHealth), including the Health Safety Net Office Subject Matter of Regulation: ACA Medicaid Eligibility Expansion and other ACA Related Changes Regulation No: 101 CMR : Health Safety Net Eligible Services (new) CMR 13.00: Health Safety Net Eligible Services (repealing) 130 CMR : General Policies 130 CMR : Request for Benefits 130 CMR : Universal Eligibility Requirements 130 CMR : Citizenship and Immigration 130 CMR : Coverage Types 130 CMR : Financial Requirements 130 CMR : Other Related Benefits 130 CMR : Managed Care Requirements 130 CMR : General Policies 130 CMR : Eligibility Process 130 CMR : Universal Eligibility Requirements 130 CMR : Citizenship and Immigration 130 CMR : Coverage Types 130 CMR : Financial Eligibility 130 CMR : Related Program Benefits 130 CMR : Independent Clinical Laboratory Services 130 CMR : Home Health Agency Services 130 CMR : Community Health Center Services 130 CMR : Pharmacy Services 130 CMR : Acute Outpatient Hospital Services 130 CMR : Acute Inpatient Hospital Services 130 CMR : Family Planning Agency Services 130 CMR : Freestanding Ambulatory Surgical Center Services 130 CMR : Podiatrist Services 130 CMR 130 CMR : Independent Diagnostic Testing Services 130 CMR : Physician Services 130 CMR : Administrative and Billing Regulations 130 CMR : Fair Hearing Rules 130 CMR : Insurance Partnership (repealing) 1

4 Statutory Authority: M.G.L. c. 118E, 7 and 12 Other Agencies Affected: None Other Regulations That May Duplicate or Conflict with the Regulation: None Describe the Scope and Objectives of the Regulation: The proposed changes to MassHeaIth regulations are intended to conform with the changes to eligibility, benefits and operational processes that will be implemented in accordance with the Affordable Care Act (ACA) and consistent with the Commonwealth's plans for implementation of the ACA as authorized in the FY2014 budget and the 2012 and 2013 ACA state legislative packages. Specifically, the regulation changes implement the categorical and fmancial requirements for MassHealth programs mandated by the ACA and changes in Massachusetts state law. In addition, the proposed regulations describe operational changes in the application and redetermination processes. Most of the regulation changes do not have any direct impact on small businesses. However, one of the changes is the discontinuation as of of the Insurance Partnership program, which provides subsidies to qualifying small businesses and their low income employees for the purchase of employer-sponsored health insurance. 2,759 small employers currently participate in the Insurance Partnership program. While the Insurance Partnership subsidies will be discontinued, these employers may be able to receive federal tax credits toward the purchase of insurance for their employees through the Health Connector starting in In addition, new, more affordable options for small businesses may be available through the Health Connector's Small Business Health Insurance Options Program (SHOP) offerings in In addition, one of the major changes included in these regulations is the expansion of MassHealth eligibility to all adults earning up to 133 percent of the Federal Poverty Level (FPL), as authorized by the ACA. Many health care providers may be small businesses, and they may experience an increase in patient care volume as a result of more individuals having health coverage through MassHealth. Business Industry(ies) Affected by the Regulation: Health care Types of Businesses Included in the Industry(ies): Health care providers including hospitals, physician practices, and community health centers. Total Number of Small Businesses Included in the Regulated Industry(ies) Please see the attached guidance documents for assistance determining the total number of small businesses: None Number of Small Businesses Potentially Subject to the Proposed Regulation: 2,759 will be directly affected by the regulation as a result of the discontinuation of the Insurance Partnership. Effective Date Used In Cost Estimate: Jahuary 1,2014 2

5 Yes No *Note: For each question, please answer 'yes" or "no" and offer a brief explanation. Please describe any facts, data, views, arguments, or other input from small businesses, organizations or any other sources that were used to quantify the impacts outlined below. Yes No Will small businesses have to create, file, or issue additional reports? D IZI Yes No Will small businesses have to implement additional record keeping procedures? Yes No Will small businesses have to provide additional administrative oversight? Yes No Will small businesses have to hire additional employees in order to comply with the proposed regulation? Yes No Does compliance with the regulation require small businesses to hire other professionals (e.g. a lawyer, accountant, engineer, etc.)? Yes No Does the regulation require small businesses to purchase a product or make any other capital investments in order to comply with the regulation? Yes No Are performance standards more appropriate than design standards? Yes No Does the regulation require small businesses to cooperate with audits, inspections, or other regulatory enforcement activities? Yes No Will the regulation have the effect of creating additional taxes and/or fees for small businesses? Yes No Does the regulation require small businesses to provide educational services to keep up to date with regulatory requirements? Yes No Is the regulation likely to deter the formation of small businesses in Massachusetts? The end of the Insurance Partnership may have a small negative effect on the 2,759 small 3

6 D ~ businesses that currently participate in the program, but this effect is not significant enough to deter the formation of small businesses in Massachusetts. Small businesses will have expanded options for purchasing affordable health insurance for their employees through the Health Connector in Yes No Is the regulation likely to encourage the formation of small businesses in Massachusetts? [8J 0 Yes, the regulation is likely to encourage formation of small businesses because it will increase demand for health care services for newly eligible MassHealth members. Yes No Can the regulation provide for less stringent compliance or reporting requirements for small businesses? Yes No Can the regulation establish less stringent schedules or deadlines for compliance or reporting requirements for small businesses? Yes No Can the compliance or reporting requirements be consolidated or simplified for small D ~ businesses? Yes No Can performance standards for small businesses replace design or operational standards? Yes No Are there alternative regulatory methods that would minimize the adverse impact on small businesses? Yes No Were any small businesses or small business organizations contacted during the preparation of this document? If so, please describe. EOHHS has engaged in extensive stakeholder outreach in preparation for the changes under the ACA, including outreach to health care providers, some of which are small businesses. EOHHS will continue and expand these outreach efforts in the coming months as ACA implementation draws closer. 4

Division of Health Care Finance and Policy

: A Report by the Executive Office of Health and Human Services Division of Health Care Finance and Policy Submitted in compliance with Section 35 of Chapter 118G December 2010 Deval L. Patrick, Governor