“Cliff’s Notes” for the Eligibility NPRM

For those of us well beyond our school years, the idea of cramming for an exam or relying on crib notes to get ready for a test may be less familiar, but the image of a student huddling over a copy of Cliff’s Notes came to mind this week as we think about so many state officials and others rushing to finish their comments on the massive eligibility and exchange proposed rules before October 31.  How can states with so much already on their plate running their programs, planning for Medicaid and CHIP expansions and system changes, and building new Exchanges and IT systems also read, assimilate and comment on these very technical and detailed rules without a little extra help?   In consideration of states’ challenges here, Maximizing Enrollment/NASHP is joining the ranks of other organizations to support state understanding the rules and submit meaningful comments to ensure that federal agencies get the best information they can about the rules and their implications for states.  How?  By doing our own “Cliff’sNotes” analysis for states.
Today, NASHP is sharing our brief, just-the-facts analysis created by the Maximizing Enrollment staff, which we are calling a Regulatory Analysis grid.  This grid outlines the key provisions of the three eligibility notices of proposed rulemaking (from CMS and IRS) that were issued on August 17, 2011.  In our grid, we provide a summary of the key provisions in each section of the rule, raise key questions or issues that states and the federal agencies will want to consider in finalizing the policy, and signal for states the areas where CMS has specifically asked for more guidance from states.  We are hoping this is a useful tool to help those states and other policymakers still formulating their comments to understand, at a minimum, what the rule does and where federal agencies are specifically seeking input and comment.
We are aware that this grid is by no means the only tool available to states.  CMS issued its ownsummary of the rule, which is very useful.  Manatt Health Policy Systems created an excellentanalysis for Robert Wood Johnson Foundation’s State Health Reform Assistance Network project.  Health Reform GPS created another very useful summary.  There are likely other analyses you have seen or are using in your states.
What we hope our grid will add to this growing body of work is a capacity for states to be able to quickly reference parts of the rule, check for issues to raise and easily understand where, at a minimum, states need to be weighing in with federal agency partners.  These rules will have far-reaching implications for how states determine eligibility, enroll and renew individuals for years to come and will have a dramatic impact on how states structure their eligibility processes, how work is performed, the systems used, and, ultimately, how individuals eligible to enroll in coverage are served.
CMS and IRS have repeatedly ask for states to provide written comments on the rules so they can make policy based on sound information about how these provisions will work on the ground.  States will know best the answers to these questions and should sharpen their pencils and share their thoughts with CMS and IRS before the deadline.  You can also share ideas with other states as part of a conversation at State Refor(u)m. Believe us, this is one test states won’t want to miss!