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TxSCO Regulatory Issues

It is expected that the Centers for Medicare and Medicaid Services (CMS) will release the final rule for state exchanges soon. It is expected the final rule will mirror the proposed rule in leaving flexibility to the states to design their own exchanges.

Exchanges in each state are scheduled to be operational by January 1, 2014. Here is what we saw in the proposed rule: a few basic ground rules, but significant decision making remains with the states in most areas.

There are still some outlying questions to be answered concerning the logistics of creating a state exchange. We are still waiting to learn the process for eligibility determinations and appeals for those determinations; the standards for ongoing federal oversight of exchanges; the definition of "essential health benefits" for each state; and quality data reporting requirements.

We will update this information as soon as the CMS Final Rules on State Exchanges are released.


Co-insurance/Deductible Payments for Dual Eligibles

Texas Health and Human Services Commission has released a rule to eliminate co-insurance/deductible payments for dual eligible patients. TxSCO strongly opposes this rule and submitted a letter to HHSC requesting these cuts be avoided. Thank you to members who also submitted their own letters. You can view the TxSCO letter here.


Please contact Leah Ralph at if you have any questions.

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