mmpc - National Indian Health Board

i. CMS stated on a couple of occasions that states have the ability to
apply additional standards on QHP than the minimum standards
established by CMS
- Imposing a requirement that all QHP’s in a state Exchange
must offer to contract with I/T/U would be allowable.
ii. CMS stated they would need to issue additional formal
regulations if the FFE were to impose additional requirements on
QHP, such as requiring a plan to offer to contract with each I/T/U.
- CMS staff also indicated that, while it is not certain and
they didn’t offer to include any AI/AN-specific provisions if
they do, it is likely that CMS will be issuing further formal
guidance on the FFE.
f. Who should tribes engage in tribal consultation with regarding Exchange
operations?
i. For state-based Exchanges, state officials.
ii. For strictly FFE, engage CMS but no explanation was given yet of
how tribes will engage CMS on state-specific issues that may
apply solely to one specific state FFE (versus the discussions
going on now between TTAG and CMS on the national FFE
design.)
iii. For Partnership exchanges, engage states on the specific
functions a state may decide to operate.
- Plan management (e.g., certification of QHP)
- Outreach and enrollment assistance (e.g., Navigator
program and “in-person assistance”)
g. Liability for tax penalty for certain IHS beneficiaries
- In response to questions, the IHS Director and CMS staff
acknowledged that some IHS beneficiaries who choose not to
purchase health insurance coverage and who do not meet the
definition of Indian under the IRC definition could be liable for the
tax penalty administered by the IRS for not having “creditable
coverage”.
h. Analysis of impact of Medicaid expansion on states
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