Some of the issues initially created by the pandemic that delayed engaging in an interactive process and/or providing reasonable accommodation may no longer exist. If Medicaid recoups funds paid to a provider, the provider may bill Medicare, which may require the provider to obtain an exception to Medicare's 1-year timely filing requirement as described in CMS guidance published in Pub. Specifically, they stated that the Medicare Part A changes would be effective in 2023 and the Medicare Part B proposed changes would be effective in 2022, and they recommended that these proposals be implemented simultaneously. Several comments expressed support for our proposal to replace the old stand-alone agreements by specifying that the provisions of a State buy-in agreement shall be set forth in the State Medicaid plan. in the buy-in agreement could not enroll in Medicare outside of enrollment periods using the proposed SEP. The ADA business necessity standard requires that employers utilize the most current medical and public health information to determine what inquiries/medical examinations are appropriate. As such, they would have no role in coordination of benefits for Part B-ID. In addition, beneficiaries who opt for retroactive coverage must pay the premiums for that coverage and we note that installment billing plans are available for beneficiaries who cannot pay the lump sum of retroactive premiums. In that case the determination of SSDI eligibility for a retroactive period for the individual means that the individual's premium-free Part A entitlement is retroactive as well. D.11. (b) Federal departments and agencies should consult the website of the Safer Federal Workforce Task Force for the latest guidance on federal agency operations during the COVID-19 pandemic. California voters have now received their mail ballots, and the November 8 general election has entered its final stage. Under the ADA, it is unlawful for an employer to disclose that an employee is receiving a reasonable accommodation or to retaliate against an employee for requesting an accommodation. However, we share the commenters' concerns about gaps in health coverage as individuals transition from Medicaid to Medicare health coverage. Get it as soon as Sunday, Nov 13. Assuming the employee has a disability as discussed above, if the employer is concerned that the health of an employee with a disability may be jeopardized upon returning to the workplace, the ADA generally does not allow the employer to exclude the employeeor take any other adverse actionbecause the employee has a disability that CDC identifies as potentially placing the employee at higher risk for severe illness if the employee gets COVID-19. Section 1837(l) of the Act establishes a 12-month SEP for certain individuals who are enrolled in TRICARE and become eligible to enroll in Part A on the basis of disability or ESRD status under sections 226(b) or 226A of the Act, respectively, but who elect not to enroll (or to be deemed enrolled) during their IEP. To remove barriers that present an exceptional condition that could prevent individuals from transitioning from coverage under the Medicaid program to coverage under the Medicare program, we proposed an SEP at 406.27(e) and 407.23(e) for individuals who lose Medicaid eligibility entirely after the COVID-19 PHE ends or on or after January 1, 2023 (whichever is earlier) and have missed a Medicare enrollment period. Section 1838(a) of the Act establishes the beginning of entitlement for Part B for individuals who enroll in their IEP or GEP. Effective January 1, 2023, 407.1 is amended by adding paragraph (a)(6) and revising paragraph (b) to read as follows: (6) Sections 1836(b) and 1837(n) of the Act provide for coverage of immunosuppressive drugs as described in section 1861(s)(2)(J) of the Act under Part B beginning on or after January 1, 2023, for eligible individuals whose benefits under Medicare Part A and eligibility to enroll in Part B on the basis of ESRD would otherwise end with the 36th month after the month in which the individual receives a kidney transplant by reason of section 226A(b)(2) of the Act. We believe this issue can best be addressed by finalizing our proposal with modifications to allow eligible individuals to choose between 2 effective dates of coverage: We understand that this population of beneficiaries may face job insecurity and socio-economic barriers while reintegrating into their communities. During the last 2 months of their IEP or deemed IEP, their entitlement under Medicare would be effective beginning with the first day of the third month after the month in which he or she enrolls according to sections 1838(a)(2)(B)(iii) and 1838(a)(3)(B)(i) of the Act. (5/28/21). According to CDC guidance, an individual who has COVID-19 or symptoms associated with it should not be in the workplace. Third, we proposed to add new 435.124 for the SLMB eligibility group and new 435.125 for the QI eligibility group described in section 1902(a)(10)(E)(ii) and (iv) of the Act, respectively. A commenter expressed appreciation for this update, and the clarity of the proposed revisions, due to confusion at the State level about some of the details in these regulations. These CDC designations, or any other designations of certain employees, do not eliminate coverage under the ADA or the Rehabilitation Act, or any other equal employment opportunity law. We proposed updating 431.625(d)(1) to eliminate the reference to title IV-A, which has been repealed. Why is the Texas State Guard limited to only 30 Members per semester for State TA? Response: This timeframe is also articulated in Section 120 of the CAA. The first of these presidential debates took place on September 26, 2016, and set the record as the most The individual will also affirm that the statement provided was true and correct and that the individual acknowledged that there may be criminal penalties for making a false statement for purposes of obtaining these Medicare benefits. Under the ADA, an employer may require an individual with a disabilityto meet a qualification standard applied to all employees, such as a safety-related standard requiring COVID-19 vaccination, if the standard is job-related and consistent with business necessity as applied to that employee. If an employer is hiring, may it screen applicants for symptoms of COVID-19? The ADA requires an employer to maintain the confidentiality of employee medical information. will need to make a plan for system changes, we projected an aggregate burden of $12,510,748.8 (51 (50 States and DC) * 2,000 hr * $92.92/hr * 3 * States' average FMAP rate). A second MSP eligibility group is the Specified Low-Income Medicare Beneficiary (SLMB) group, which provides medical assistance through coverage of Part B premiums for individuals who would otherwise be eligible in the QMB eligibility group, except that their income exceeds 100 percent of the FPL and is below 120 percent of the FPL as defined at section 1902(a)(10)(E)(iii) of the Act. for better understanding how a document is structured but These are only a few ideas. In addition, while the statutory provisions of section 120 of the CAA primarily affect individuals enrolling in Part B, those changes will also affect the requirements applicable to the limited number of individuals enrolling in Part A who are not entitled to premium-free Part A. 36. Others noted that our proposals would expand access to the Medicare Savings Programs and improve their functionality. Effective January 1, 2023, 435.124 is added to read as follows: (a) Response: Entitlement begins the first day of the month following the month of enrollment, so long as the date is on or after January 1, 2023. Part B-ID premiums are to be deducted following the rules set forth in 408.40. Full-benefit Medicaid coverage, in the context of individuals who are considered dually eligible, generally refers to the package of services, beyond coverage for Medicare premiums and cost sharing, that certain individuals are entitled to under 440.210 and 440.330. For beneficiaries enrolled in MSPs for coverage of premiums and cost sharing of the Part B-ID benefit, States will incur premium and cost sharing costs for the benefit as well as costs associated with systems and other changes needed for reporting enrollment in these MSPs as described in further detail elsewhere in this document. We estimated that it would take a maximum of 12 months of work (approximately 2,000 hours) by three computer programmers working $92.92/hr to make the necessary systems changes. Register, and does not replace the official print version or the official According to Mayo Clinic, A preemptive kidney transplant is when you receive a kidney transplant before your kidney function deteriorates to the point of needing dialysis to replace the normal filtering function of the kidneys.. Progressive lenses and trifocals offer some help for intermediate vision. Comment: Response: Currently, an individual's entitlement (coverage period effective date) under Part B depends on the enrollment period and the month in which the individual enrolls, according to the requirements in sections 1837 and 1838 of the Social Security Act (the Act). The State TA application form for the Fall 2022 - Spring 2023school year is A. Information Collection Requirements (ICRs), 1. In many circumstances, it may be possible to accommodate those seeking reasonable accommodations for their religious beliefs, practices, or observances without imposing an undue hardship. which is updated quarterly. Response: (f) The commenter described several competing system priority updates in the next calendar year and inability to add any new coverage group and benefit not already in its previously planned system updates until the end of 2023. 42. . (2) Have income, subject to paragraphs (b)(2)(1)(i) and (ii) of this section, that is less than or equal to 200 percent of the federal poverty level. "The holding will call into question many other regulations that protect consumers with respect to credit cards, bank accounts, mortgage loans, debt collection, credit reports, and identity theft," tweeted Chris Peterson, a former enforcement attorney at the CFPB who is now a law With regard to the commenters' question if a fee is included for the administration of IM and IV formulations under the Part B-ID benefit, as we stated above, section 402(a) of the CAA provides that the benefits are solely for purposes of coverage of immunosuppressant drugs described in section 1861(s)(2)(J). We also use cookies set by other sites to help us deliver content from their services. Response: These sources may guide employers when choosing questions to ask employees to determine whether they would pose a direct threat to health in the workplace. An employers concern for an applicants well-being -- an intent to protect them from what it perceives as a risk of illness from COVID-19 -- does not excuse an action that is otherwise unlawful discrimination. Who in the organization needs to know the identity of the employee will depend on each workplace and why a specific official needs this information. Schedule changes should be reported by submitting an updated course schedule and fee statement to the Education Office. While we understand that COBRA interaction with Medicare may be confusing, we are unable to make the assumption that enrollment in COBRA was caused by misinformation provided by an employer or group health plan. No. Another commenter noted States may be required to pay retroactive premiums for periods greater than 36 months in situations in which an individual loses Medicaid coverage, later enrolls in Medicare, and subsequently regains Medicaid eligibility with a retroactive start date that overlaps with the previous Medicaid termination date. (4/9/20). We are also revising 406.27(b)(2) and 407.23(b)(2) to extend the duration of the SEP to 6 months after the end of the emergency declaration. The commenter also suggested that the statutorily identified excepted plans may not be as robust as Medicare Part B-ID, but the individuals would still be precluded from enrolling in Part B-ID. However, upon review, we have decided to extend the SEP duration from 2 months to 6 months in order to provide greater flexibility for potential Medicare beneficiaries. A commenter expressed concern about inaccuracies in data exchanges between States and federal agencies regarding individuals' Part B-ID status at the start of the program. For example, it may be significantly more difficult in this pandemic to conduct a needs assessment or to acquire certain items, and delivery may be impacted, particularly for employees who may be teleworking. We estimate that individuals attesting telephonically or via a paper or PDF attestation form, (as well as future fax or online options), will have the same time of 10 minutes (0.167 hr) per response. Protected activity can take many forms. Asking why an individual did not report to work is not a disability-related inquiry. (ii) An employer, GHP, agent or broker of a health plan, or their representative materially misrepresented information or provided incorrect information relating to enrollment in premium Part A. LockA locked padlock A person infected with the virus causing COVID-19 who is asymptomatic or a person whose COVID-19 results in mild symptoms similar to those of the common cold or flu that resolve in a matter of weekswith no other consequenceswill not have an actual disability within the meaning of the ADA. In general, the individual must have income that does not exceed 100 percent of the federal poverty line (FPL) and resources that do not exceed 3 times the limit for SSI with adjustments for inflation as described in section 1905(p)(1) of the Act. As used in this subpart, unless the context indicates otherwise. Counts are subject to sampling, reprocessing and revision (up or down) throughout the day. In 1972, Congress enacted section 299I of the Social Security Amendments of 1972 (Pub. We note that under 1837(g)(1) of the Act an individual will have a new IEP for each continuous period of Medicare eligibility as defined by section 1839(d) of the Act and upon attainment of age 65. Unlike Part B (or other parts of the Medicare program) where individuals can only enroll during an enrollment period, if an individual is eligible for the Part B-ID benefit, they can enroll at any time and will not be subject to an LEP for months of non-coverage. B.6. Comment: CMS-40-F became obsolete in 2008. Guidance from medical and public health authorities may be relevant to making certain legal determinations under one or more EEO laws (e.g., direct threat under the ADA). beneficiaries. Yes. Further information on education and outreach to inform beneficiaries and stakeholders about the Part B-ID benefit is discussed in section II.B.5 of this final rule. The tiring of these muscles leads to discomfort and visual symptoms. Second, we proposed to revise the definition for aid to families with dependent children (AFDC) because some Medicaid eligibility groups remain tied to AFDC, as that program existed as of July 16, 1996, prior to its elimination. (12/14/21). We have limited means of estimating how many individuals will opt to terminate their Part B-ID benefit as this immunosuppressive drug benefit is yet to be implementedthe statutory effective date is January 1, 2023. Response: Are the circumstances of the pandemic relevant to whether a requested accommodation can be denied because it poses an undue hardship? Therefore, OMB has reviewed these regulations, and the Department has provided the following assessment of their impact. 22. 4. CDC identifies a number of medical conditions that are more likely to cause people to get severely ill if they get COVID-19. Eligibility. L.1. Section 1903(a)(1) and (b) of the Act authorize federal financial participation (FFP) for such State payment of Part B premiums for certain dually eligible individuals. Comment: Start Printed Page 66509. However, the See also 29 CFR 1605. While some individuals in Medicaid who are eligible for Medicare will lose eligibility for Medicaid upon the end of the COVID-19 PHE, others will not. (4/9/20). [13] Specifically, they wanted to know how we will designate the SEP reason codes and if they will be released as part of new CY 2023 guidance. A determination of direct threat also would include whether the employee is up to date on vaccinations and the likelihood that an individual may be exposed to the virus at the worksite. SEP duration. Yes. Single vision computer glasses reduce the risk of eye strain, blurred vision and unnatural posture that can cause neck and back pain. This modification clarifies that Medicaid-eligible deemed AFDC recipients, if included in State buy-in agreements, must encompass individuals eligible for Medicaid on the basis of section 1931(b) of the Act as well as individuals eligible for Medicaid based on their receipt of adoption assistance, foster care, or guardianship care under Part E of title IV of the Act. Our office will email youa Document List once the semester begins listing thedocuments needed. So, it is important for the employer to consider why it wishes to take these actions regarding this particular employee, such as a display of COVID-19 symptoms. (4) A State child health plan (or waiver of such plan) under title XXI and is eligible to receive benefits for such drugs under such plan (or such waiver). Executive Order on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government. 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