Health and Human Services Department Documents and Publications

SUMMARY: This notice requests comments to assist in the development of a model process for the coordination of enrollment, retention, and coverage for low-income Medicaid and Children's Health Insurance Program eligible children as required under the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009. CHIPRA requires this model process to be developed by August 4, 2010 and the Secretary is required to submit a Report to Congress describing additional steps or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of low-income children who frequently change their State of residence.

DATES: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on January 19, 2010.

ADDRESSES: In commenting, please refer to file code CMS-2311-NC. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of four ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the instructions under the "More Search Options" tab.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2311-NC, P.O. Box 8010, Baltimore, MD 21244-8010.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-2311-NC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments before the close of the comment period to either of the following addresses:

a. For delivery in Washington, DC--Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.

If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members.

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Wanda Pigatt-Canty, (410) 786-6177. Mary Corddry, (410) 786-6618.

SUPPLEMENTARY INFORMATION: Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.

Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.

I. Background

Section 213 "Model of Interstate Coordinated Enrollment and Coverage Process" of the Children's Health Insurance Program Reauthorization Act (CHIPRA) of 2009 requires the Secretary of Health and Human Services (HHS), in consultation with State Medicaid and Children's Health Insurance Program (CHIP) directors and organizations representing program beneficiaries, to develop a model process by August 4, 2010, that assures the continuity of coverage for low-income children under Medicaid and CHIP. The model process will be designed for the coordination of enrollment, retention, and coverage for children under the Medicaid and CHIP programs, who, because of migration of families, emergency evacuations, natural, or other disasters, public health emergencies, educational needs, or otherwise, frequently change their State of residence or are temporarily located outside their State of residence. American Indian and Alaska Native children who need care while attending boarding schools or need culturally appropriate care available only in a State where they do not reside are a key example of this population.

CHIPRA requires the Secretary, after developing a model process, to submit a Report to Congress that would describe additional steps or authority needed to make further improvements to coordinate the enrollment, retention, and coverage under CHIP and Medicaid of low-income children who frequently change their State of residence or are temporarily located outside their State of residence.

A. CMS Historical Experience Related to Continuity of Coverage

In 2006, CMS prepared a Report to Congress as required by section 404 of the Health Care Safety Net Amendments Act of 2002 (Pub. L. 107-251) entitled "Study Regarding Barriers to Participation of Farm Workers in Health Programs." This report highlighted problems experienced by migrant farmworkers and their families related to the barriers encountered in accessing health services through Medicaid and CHIP, and the lack of portability of Medicaid and CHIP coverage for farmworkers who are determined eligible in one State but who, due to the seasonal nature of the their work, periodically move to other States. We published the outcome of this study in a Report to Congress which identified five options to address the portability issues related to Medicaid and CHIP. The recommended options included the following:

* Interstate Compacts.

* Demonstration Projects.

* State Activities under Current Law Flexibility.

* National Migrant Family Coverage.

* Public-Private Partnerships.

The full Migrant Farmworkers Report to Congress can be viewed at: http://cms.hhs.gov/Reports/Downloads/RTC-Leavitt2.pdf.

B. Proposed Models for Coordination

We are using some of the recommendations from the Migrant Farmworkers Report to Congress as the basis for proposing models of coordination/portability to attempt to solve the problem of gaps in healthcare coverage for Medicaid and CHIP children who frequently change their State of residence. We have identified four proposed models including a new model titled "National Children's Health Coverage Option" on which we are seeking input. These models include:

(1) Interstate Compacts. Under current Federal law and regulations, States may enter interstate agreements to facilitate administration of their Medicaid and CHIP programs. Interstate compacts are agreements between States that provide the framework for formalized interstate cooperation. The framework ranges from a more basic model in which States recognize each other's eligibility determinations to models with States fully reimbursing out-of-state providers. States may seek to develop interstate agreements or compacts to facilitate timely eligibility determinations or redeterminations for applicants and recipients, such as migrant farmworkers, and agree upon detailed mechanisms by which payment reciprocity can be made among two or more States. These interstate arrangements, however, do not necessarily require Federal approval. By establishing and joining an interstate compact on Medicaid and CHIP for children, States can more readily recognize each other's eligibility determinations and reimburse out-of-state providers. As a result, they can provide more seamless Medicaid and CHIP coverage to low-income children. States currently participate in a variety of interstate compacts including one pertaining to Federal adoption assistance/Medicaid recipients entitled the "Interstate Compact on Adoption and Medical Assistance" (ICAMA). Further information related to ICAMA can be viewed at: http://www.aaicama.org/cms/.

--This is a summary of a Federal Register article originally published on the page number listed below--

Notice with comment.

Citation: "74 FR 67232"

Document Number: "CMS-2311-NC"

Federal Register Page Number: "67232"

"Notices"