{"abstract":"This final rule implements provisions of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the Affordable Care Act. This final rule finalizes new Medicaid eligibility provisions; finalizes changes related to electronic Medicaid and the Children's Health Insurance Program (CHIP) eligibility notices and delegation of appeals; modernizes and streamlines existing Medicaid eligibility rules; revises CHIP rules relating to the substitution of coverage to improve the coordination of CHIP coverage with other coverage; and amends requirements for benchmark and benchmark- equivalent benefit packages consistent with sections 1937 of the Social Security Act (which we refer to as \"alternative benefit plans\") to ensure that these benefit packages include essential health benefits and meet certain other minimum standards. This rule also implements specific provisions including those related to authorized representatives, notices, and verification of eligibility for qualifying coverage in an eligible employer-sponsored plan for Affordable Insurance Exchanges. This rule also updates and simplifies the complex Medicaid premium and cost sharing requirements, to promote the most effective use of services, and to assist states in identifying cost sharing flexibilities. It includes transition policies for 2014 as applicable.","action":"Final rule.","agencies":[{"raw_name":"DEPARTMENT OF HEALTH AND HUMAN SERVICES","name":"Health and Human Services Department","id":221,"url":"https://www.federalregister.gov/agencies/health-and-human-services-department","json_url":"https://www.federalregister.gov/api/v1/agencies/221","parent_id":null,"slug":"health-and-human-services-department"},{"raw_name":"Centers for Medicare & Medicaid Services","name":"Centers for Medicare & Medicaid Services","id":45,"url":"https://www.federalregister.gov/agencies/centers-for-medicare-medicaid-services","json_url":"https://www.federalregister.gov/api/v1/agencies/45","parent_id":221,"slug":"centers-for-medicare-medicaid-services"},{"raw_name":"Office of the Secretary"}],"body_html_url":"https://www.federalregister.gov/documents/full_text/html/2013/07/15/2013-16271.html","cfr_references":[{"chapter":null,"citation_url":null,"part":431,"title":42},{"chapter":null,"citation_url":null,"part":435,"title":42},{"chapter":null,"citation_url":null,"part":436,"title":42},{"chapter":null,"citation_url":null,"part":438,"title":42},{"chapter":null,"citation_url":null,"part":440,"title":42},{"chapter":null,"citation_url":null,"part":447,"title":42},{"chapter":null,"citation_url":null,"part":457,"title":42},{"chapter":null,"citation_url":null,"part":155,"title":45},{"chapter":null,"citation_url":null,"part":156,"title":45}],"citation":"78 FR 42160","comment_url":null,"comments_close_on":null,"correction_of":null,"corrections":[],"dates":"The effective date for the additions of 42 CFR 435.118, 435.603, 435.911, 435.949, 435.956, 435.1200, 457.315, 457.330 and 457.348; amendments to 42 CFR 431.10, 431.11, 435.110, 435.116, 435.119, 435.907, 435.916, 435.940, 435.945, 435.948, 435.952, 457.340 and 457.350; the removal of 42 CFR 435.953 and 435.955; and the redesignation of 42 CFR 435.911 through 435.914 as 42 CFR 435.912 through 435.915 in CMS-2349 (FR Doc. 2012-6560) published on March 23, 2012, which were to become effective in January 1, 2014 are now effective October 1, 2013.","disposition_notes":null,"docket_ids":["CMS-2334-F"],"dockets":[],"document_number":"2013-16271","effective_on":"2012-03-23","end_page":42322,"executive_order_notes":null,"executive_order_number":null,"explanation":null,"full_text_xml_url":"https://www.federalregister.gov/documents/full_text/xml/2013/07/15/2013-16271.xml","html_url":"https://www.federalregister.gov/documents/2013/07/15/2013-16271/medicaid-and-childrens-health-insurance-programs-essential-health-benefits-in-alternative-benefit","images":{},"images_metadata":{},"json_url":"https://www.federalregister.gov/api/v1/documents/2013-16271?publication_date=2013-07-15","mods_url":"https://www.govinfo.gov/metadata/granule/FR-2013-07-15/2013-16271/mods.xml","not_received_for_publication":null,"page_length":163,"page_views":{"count":76592,"last_updated":"2026-04-14 22:15:04 -0400"},"pdf_url":"https://www.govinfo.gov/content/pkg/FR-2013-07-15/pdf/2013-16271.pdf","presidential_document_number":null,"proclamation_number":null,"public_inspection_pdf_url":"https://public-inspection.federalregister.gov/2013-16271.pdf?1373037130","publication_date":"2013-07-15","raw_text_url":"https://www.federalregister.gov/documents/full_text/text/2013/07/15/2013-16271.txt","regulation_id_number_info":{"0938-AR04":{"issue":"201304","html_url":"https://www.federalregister.gov/regulations/0938-AR04/medicaid-exchanges-and-children-s-health-insurance-programs-eligibility-appeals-and-other-provisions","title":"Medicaid, Exchanges, and Children's Health Insurance Programs: Eligibility, Appeals, and Other Provisions Under the Affordable Care Act (CMS-2334-F)","xml_url":"http://www.reginfo.gov/public/do/eAgendaViewRule?pubId=201304&RIN=0938-AR04&operation=OPERATION_EXPORT_XML","priority_category":"Economically Significant"}},"regulation_id_numbers":["0938-AR04"],"regulations_dot_gov_info":{"supporting_documents":[],"comments_count":0,"agency_id":"HHS","comments_url":"https://www.regulations.gov/docketBrowser?rpp=50&so=DESC&sb=postedDate&po=0&dct=PS&D=HHS-OS-2022-0008","supporting_documents_count":0,"docket_id":"HHS-OS-2022-0008","document_id":"HHS-OS-2022-0008-0380","regulation_id_number":null,"title":"HHS 2022 Archive","checked_regulationsdotgov_at":"2022-05-28T03:30:05Z"},"regulations_dot_gov_url":null,"significant":true,"signing_date":null,"start_page":42160,"subtype":null,"title":"Medicaid and Children's Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment","toc_doc":"Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment","toc_subject":"Medicaid and Children's Health Insurance Programs:","topics":["Accounting","Administrative practice and procedure","Advertising","Advisory committees","Aid to Families with Dependent Children","Brokers","Consumer protection","Drugs","Grant programs-health","Grants administration","Guam","Health care","Health facilities","Health insurance","Health maintenance organizations (HMO)","Health professions","Health records","Hospitals","Indians","Individuals with disabilities","Loan programs-health","Medicaid","Organization and functions (Government agencies)","Privacy","Public assistance programs","Puerto Rico","Reporting and recordkeeping requirements","Rural areas","Safety","State and local governments","Sunshine Act","Supplemental Security Income (SSI)","Technical assistance","Virgin Islands","Wages","Women","Youth"],"type":"Rule","volume":78}