The document summarizes changes to the Money Follows the Person Rebalancing Demonstration Program as a result of the Affordable Care Act. It extends program funding through 2016 and expands eligibility to individuals residing in institutions for over 90 days rather than just 6 months. It continues providing grants, technical assistance, and an enhanced Medicaid match rate to help states transition more people from institutions to home and community-based services.
American Recovery and Reinvestment Conference Report Division Detailed summar...finance3
The document summarizes provisions from the American Recovery and Reinvestment Act of 2009 related to health care, broadband, and energy. It allocates $86.6 billion to increase Medicaid funding for states and extend health programs to help the unemployed keep their health insurance. It provides $4.7 billion in grants to expand broadband infrastructure and an additional $2.5 billion for rural broadband. It also allocates $19 billion to promote health information technology and $10 billion for energy programs including smart grid development, renewable energy loans, and weatherizing homes.
The document provides an overview of healthcare reform under the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). It discusses key provisions including the expansion of Medicaid eligibility, establishment of health insurance exchanges, essential health benefits, and various delivery system reforms aimed at improving quality of care and reducing costs.
The Road Ahead for Health Care ComplianceFrank Sheeder
The Health Care Reform Package has significant implications for health care compliance professionals. This presentation addresses many of the issues that they will be compelled to face right away, and in the next several years.
Manatt Memo On The Aca Supreme Court Ruling 6.28.12tomenders
The Supreme Court upheld the individual mandate provision of the Affordable Care Act while ruling that states can choose not to expand their Medicaid programs without losing existing Medicaid funding. This maintains key pillars of health reform like insurance exchanges and subsidies while giving states flexibility on Medicaid expansion. Attention will now focus on implementation at the state level, including whether states set up their own exchanges or partner with the federal government, and whether they accept federal funds to expand Medicaid coverage. Delivery system reforms and private stakeholders' investments in reform will continue moving forward under the Court's decision.
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
CBO reviewed possible changes to the Department of Defense’s Military Health System, analyzing the effects of those changes on the federal budget, the quality of military health care, and preparedness for wartime missions.
Presentation by Carla Tighe Murray, a senior analyst with CBO’s National Security Division, at the 93rd annual conference of the Western Economic Association.
The Child and Family Services Improvement and Innovation Act (CFSII) reauthorizes and modifies some parts of Title IV-B of the Social Security Act, which provides funding for child welfare services. It extends funding for programs through 2016. Key modifications include additional requirements for state plans regarding trauma, prescription drug monitoring, and targeting at-risk populations. It also modifies caseworker visit requirements and expands services eligible for time-limited family reunification funding.
The document provides a summary of the key provisions and implementation timelines of the Affordable Care Act (ACA) health reform legislation passed by Congress and signed into law by President Obama in 2010. It outlines what is required in the immediate future in 2010, as well as changes phased in between now and 2014 such as establishing insurance exchanges, essential benefits packages, and penalties for individuals and employers who do not obtain qualified health insurance coverage. The summary concludes by encouraging questions and feedback from readers to help with understanding and implementing the complex health reform law.
American Recovery and Reinvestment Conference Report Division Detailed summar...finance3
The document summarizes provisions from the American Recovery and Reinvestment Act of 2009 related to health care, broadband, and energy. It allocates $86.6 billion to increase Medicaid funding for states and extend health programs to help the unemployed keep their health insurance. It provides $4.7 billion in grants to expand broadband infrastructure and an additional $2.5 billion for rural broadband. It also allocates $19 billion to promote health information technology and $10 billion for energy programs including smart grid development, renewable energy loans, and weatherizing homes.
The document provides an overview of healthcare reform under the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). It discusses key provisions including the expansion of Medicaid eligibility, establishment of health insurance exchanges, essential health benefits, and various delivery system reforms aimed at improving quality of care and reducing costs.
The Road Ahead for Health Care ComplianceFrank Sheeder
The Health Care Reform Package has significant implications for health care compliance professionals. This presentation addresses many of the issues that they will be compelled to face right away, and in the next several years.
Manatt Memo On The Aca Supreme Court Ruling 6.28.12tomenders
The Supreme Court upheld the individual mandate provision of the Affordable Care Act while ruling that states can choose not to expand their Medicaid programs without losing existing Medicaid funding. This maintains key pillars of health reform like insurance exchanges and subsidies while giving states flexibility on Medicaid expansion. Attention will now focus on implementation at the state level, including whether states set up their own exchanges or partner with the federal government, and whether they accept federal funds to expand Medicaid coverage. Delivery system reforms and private stakeholders' investments in reform will continue moving forward under the Court's decision.
On Nov. 8, 2013, the DOL, HHS and the Treasury released Frequently Asked Questions (FAQs) regarding implementation of the Mental Health Parity and Addiction Equity Act. These FAQs were released in conjunction with final rules on the MHPAEA, which contain some clarification regarding the law's protections.
CBO reviewed possible changes to the Department of Defense’s Military Health System, analyzing the effects of those changes on the federal budget, the quality of military health care, and preparedness for wartime missions.
Presentation by Carla Tighe Murray, a senior analyst with CBO’s National Security Division, at the 93rd annual conference of the Western Economic Association.
The Child and Family Services Improvement and Innovation Act (CFSII) reauthorizes and modifies some parts of Title IV-B of the Social Security Act, which provides funding for child welfare services. It extends funding for programs through 2016. Key modifications include additional requirements for state plans regarding trauma, prescription drug monitoring, and targeting at-risk populations. It also modifies caseworker visit requirements and expands services eligible for time-limited family reunification funding.
The document provides a summary of the key provisions and implementation timelines of the Affordable Care Act (ACA) health reform legislation passed by Congress and signed into law by President Obama in 2010. It outlines what is required in the immediate future in 2010, as well as changes phased in between now and 2014 such as establishing insurance exchanges, essential benefits packages, and penalties for individuals and employers who do not obtain qualified health insurance coverage. The summary concludes by encouraging questions and feedback from readers to help with understanding and implementing the complex health reform law.
Revised 2015 CCS-GHPP for Xerox Training v5Harry Chang
This document provides an overview of the California Children's Services (CCS) Program and the Genetically Handicapped Persons Program (GHPP). It discusses eligibility requirements, covered services, referral processes, billing statuses, and the roles of providers. Key points include that CCS serves children with certain medical conditions who meet residential, financial, and medical eligibility, while GHPP serves adults with specified genetic diseases. Referrals are made to local CCS county offices or the state GHPP office by submitting a Service Authorization Request form. Providers must be paneled and authorized to provide services to CCS and GHPP clients.
The Oregon Medical Association's 2015 Legislative Report summarizes key bills addressed by the Oregon legislature during the 2015 session that were of importance to physicians and healthcare in Oregon. Some highlights include:
- Bills passed to provide physicians timely notice from insurers about patients' premium payment status and increase transparency around virtual credit card payments from insurers.
- A bill addressing healthcare provider incentive programs for underserved areas passed but with reductions in funding for a related study and potential sunsetting of programs.
- Legislation passed requiring individual schools and daycares to post immunization rates to improve parents' access to information.
- The report outlines other bills that passed and failed relating to issues like rural healthcare access, insurance
The Affordable Care Act is likely to have a positive impact on healthcare access, cost, and quality in the United States. It expands access to insurance coverage and eliminates barriers like pre-existing conditions. It also aims to improve quality by focusing on preventative care and linking payments to outcomes. However, challenges remain as increased demand could exacerbate provider shortages and raise costs. Accountable care organizations and public education on appropriate healthcare utilization will be important to fully realizing the goals of the Affordable Care Act.
This document summarizes two pieces of Georgia legislation related to rural health and primary care education. The first is the 2017 Preceptor Tax Incentive Program (PTIP) bill (HB 301) that aimed to provide tax credits for physicians, nurses and physician assistants who serve as preceptors for students. The second is the 2018 "Achieving Connectivity Everywhere (ACE) Act" (SB 402) that established a framework to expand broadband access across Georgia, especially in rural areas, by providing grants to public-private partnerships. The bill recognized broadband as essential for education, healthcare and more. It prioritized grants that would provide connectivity for hospitals and telehealth facilities.
The document provides an overview of key provisions and timelines in the Senate healthcare reform bill that was passed in 2010:
- Individuals can keep current health policies on a grandfathered basis until 2014 when state health insurance exchanges will be set up.
- Small businesses are eligible for tax credits to help pay employee premiums starting in 2010.
- Several new consumer protections and benefit requirements go into effect for plans in 2010-2014, including coverage of preexisting conditions for children, preventive care with no cost sharing, and allowing adult children to stay on parents' plans until age 26.
- Health insurance exchanges with standardized plans will be set up in each state starting in 2014, along with penalties for individuals
Joel Gilbertson, vice president of government and public affairs for Providence Health & Systems, provided a "Health Reform 101" presentation at the Alaska Providers Forum Sept. 2, 2010
The Rural Health Care (RHC) Program provides reduced rates to eligible rural health care providers for telecommunications and internet services used for health care. The program is administered by the Universal Service Administrative Company on behalf of the Federal Communications Commission. It has two components: the Primary Program provides discounts for monthly connectivity costs and 25% off internet access, while the Pilot Program previously supported up to 85% of costs for building broadband networks. Eligible providers include rural hospitals, clinics, health departments, and mental health centers. The application process involves requesting services, selecting service providers, and notifying the program once services are received to receive discounts.
Meghalaya, a low-income state in India, has faced challenges with inadequate healthcare access. Through a public-private partnership advised by IFC, the state of Meghalaya launched a universal health insurance program. ICICI Lombard General Insurance emerged as the winning bidder to introduce a scheme covering all Meghalaya residents, building upon an existing insurance program for the poor. The new program aims to expand coverage, reduce the financial burden of healthcare, and encourage private sector participation in the state's healthcare system.
The document summarizes key provisions of the Affordable Care Act and how they relate to rural health care. It discusses expanding insurance coverage through Medicaid expansion, health insurance exchanges, and high-risk pools for those with pre-existing conditions. It also addresses improving quality of care through initiatives like accountable care organizations and reducing hospital-acquired conditions and readmissions. Additionally, it outlines provisions to strengthen the rural health infrastructure and workforce, such as National Health Service Corps funding and programs to expand training opportunities.
This document outlines proposals for health, social services, and regional government reforms in Finland. The objectives are to coordinate regional administration, establish an appropriate division of work between different levels of government, implement a client-oriented service system based on county autonomy, and strengthen the sustainability of public finances. Key aspects of the reform include establishing 18 new counties responsible for organizing health and social services, directly electing county councils, transferring over 200,000 employees to counties, establishing regulations and financing for counties, and reducing municipal tax rates while increasing central government taxation to compensate municipalities for transferred responsibilities.
This document summarizes the positions of several Chambers of Commerce in California on ballot initiatives for the November 2016 election. It lists 16 propositions and provides a brief summary for each, including estimated fiscal impacts. The Chambers' positions include support, opposition or no business related (NBR) stance on initiatives related to education funding, healthcare, criminal justice, tobacco and marijuana policies, gun control, death penalty, and the environment.
The document discusses options for maximizing Medicaid enrollment in Maryland under health care reform. It describes how other states and federal programs actively enrolled eligible individuals through proactive strategies like determining eligibility based on existing data sources without requiring applications. Specific policies discussed for Maryland include determining Medicaid eligibility from tax data, limiting application questions to eligibility factors, allowing individuals to request eligibility determinations, basing eligibility on receipt of other benefits, and integrating eligibility across Medicaid and the health insurance exchange. The document argues these strategies can significantly increase enrollment but that affordability still needs to be addressed so low-income individuals will enroll and utilize coverage.
This letter provides guidance to states on implementing a new Medicaid eligibility group established by the Affordable Care Act. It outlines that starting in April 2010, states have the option to cover all non-disabled, non-elderly adults with incomes up to 133% of the federal poverty level. It describes rules for determining income eligibility and required benchmark benefits. States must submit amendments to their Medicaid plans by June 30, 2010 to implement this option starting April 1, 2010.
The document discusses a draft act on clients' freedom of choice for health and social services in Finland. The key points are:
1. The reform aims to ensure equal, modern and affordable health and social services by improving clients' access to care and opportunities to influence the services they use.
2. Under the new system, clients will be able to choose their services from public or private providers registered with the county. They will receive support for their choices from online resources, phone helplines or counselors.
3. Clients' needs and costs are expected to decrease as the population's health and wellbeing is more broadly supported. Higher needs clients will receive more integrated services through assessments, care plans and
Federal Student Aid provides information about the Public Service Loan Forgiveness Program. The program forgives remaining loan balances for borrowers who make 120 monthly payments while working full-time for a qualifying public service employer. Eligible loans include Direct Loans and other federal student loans consolidated into the Direct Loan program. Borrowers must be enrolled in income-driven repayment plans and make payments for 10 years. Qualifying employment includes jobs with government agencies, non-profits, and other organizations providing public services. The first loan balances will be forgiven starting in October 2017 for those meeting the program requirements.
Re-Evaluating Your Managed Care Revenue Improvement Opportunitieschriskalkhof
Within your span of control are:
1) Preparing strategically through internal/external assessments and developing contracting/pricing strategies.
2) Negotiating effectively to optimize reimbursement, payment rules, and contracts.
3) Integrating agreements into revenue management operations through the revenue cycle.
Health Reform Bulletin – Implementation Update: Women’s Preventive Health Se...CBIZ, Inc.
The women’s health services component of the Affordable Care Act’s (ACA) preventive services mandate continues to evolve. As background, the ACA requires non-grandfathered plans to provide specified preventive services at no cost to plan participants. These preventive services require coverage of certain women’s health services including contraceptive coverage. Recent challenges to this requirement have reached the Supreme Court.
Tony Ross, president of United Way of Pennsylvania, gave this presentation as part of the PA Budget Town Hall Meeting held in Scranton, PA on March 9, 2012.
The document summarizes Florida's proposed Medicaid reform plan, which includes shifting Medicaid recipients into private managed care plans through an 1115 waiver approved by the federal government. Key points of concern discussed are that the waiver lacks important operational and budget details, there are questions around how savings will be achieved, and shifting people to managed care does not necessarily reduce costs. Concerns are raised that the proposed reforms could reduce services and shift costs to other groups. The document calls for slowing down approval of the waiver until more details are available to properly evaluate the impact of the proposed changes.
Implementing the Affordable Care Act: Redesigning and Coordinating Eligibilit...NASHP HealthPolicy
The document discusses the challenges states will face in implementing the Affordable Care Act's requirements for coordinating eligibility and enrollment across Medicaid, CHIP, and health insurance exchanges. It notes that Kansas' current eligibility system is outdated and unable to handle the increased load. Kansas plans to use an HRSA grant to build a new integrated online eligibility system that can determine eligibility for Medicaid, subsidies, and private plans in real time. However, many questions around coordination and operational details between state and federal agencies remain unanswered as deadlines approach.
This document summarizes key points from a presentation on rural health issues and healthcare reform. It discusses potential government shutdowns if a budget is not passed, changes to Medicare and Medicaid under the Affordable Care Act, provisions already in effect, and new delivery models like accountable care organizations. Key uncertainties are noted, such as the impact of healthcare reform on rural providers and workforce shortages.
Revised 2015 CCS-GHPP for Xerox Training v5Harry Chang
This document provides an overview of the California Children's Services (CCS) Program and the Genetically Handicapped Persons Program (GHPP). It discusses eligibility requirements, covered services, referral processes, billing statuses, and the roles of providers. Key points include that CCS serves children with certain medical conditions who meet residential, financial, and medical eligibility, while GHPP serves adults with specified genetic diseases. Referrals are made to local CCS county offices or the state GHPP office by submitting a Service Authorization Request form. Providers must be paneled and authorized to provide services to CCS and GHPP clients.
The Oregon Medical Association's 2015 Legislative Report summarizes key bills addressed by the Oregon legislature during the 2015 session that were of importance to physicians and healthcare in Oregon. Some highlights include:
- Bills passed to provide physicians timely notice from insurers about patients' premium payment status and increase transparency around virtual credit card payments from insurers.
- A bill addressing healthcare provider incentive programs for underserved areas passed but with reductions in funding for a related study and potential sunsetting of programs.
- Legislation passed requiring individual schools and daycares to post immunization rates to improve parents' access to information.
- The report outlines other bills that passed and failed relating to issues like rural healthcare access, insurance
The Affordable Care Act is likely to have a positive impact on healthcare access, cost, and quality in the United States. It expands access to insurance coverage and eliminates barriers like pre-existing conditions. It also aims to improve quality by focusing on preventative care and linking payments to outcomes. However, challenges remain as increased demand could exacerbate provider shortages and raise costs. Accountable care organizations and public education on appropriate healthcare utilization will be important to fully realizing the goals of the Affordable Care Act.
This document summarizes two pieces of Georgia legislation related to rural health and primary care education. The first is the 2017 Preceptor Tax Incentive Program (PTIP) bill (HB 301) that aimed to provide tax credits for physicians, nurses and physician assistants who serve as preceptors for students. The second is the 2018 "Achieving Connectivity Everywhere (ACE) Act" (SB 402) that established a framework to expand broadband access across Georgia, especially in rural areas, by providing grants to public-private partnerships. The bill recognized broadband as essential for education, healthcare and more. It prioritized grants that would provide connectivity for hospitals and telehealth facilities.
The document provides an overview of key provisions and timelines in the Senate healthcare reform bill that was passed in 2010:
- Individuals can keep current health policies on a grandfathered basis until 2014 when state health insurance exchanges will be set up.
- Small businesses are eligible for tax credits to help pay employee premiums starting in 2010.
- Several new consumer protections and benefit requirements go into effect for plans in 2010-2014, including coverage of preexisting conditions for children, preventive care with no cost sharing, and allowing adult children to stay on parents' plans until age 26.
- Health insurance exchanges with standardized plans will be set up in each state starting in 2014, along with penalties for individuals
Joel Gilbertson, vice president of government and public affairs for Providence Health & Systems, provided a "Health Reform 101" presentation at the Alaska Providers Forum Sept. 2, 2010
The Rural Health Care (RHC) Program provides reduced rates to eligible rural health care providers for telecommunications and internet services used for health care. The program is administered by the Universal Service Administrative Company on behalf of the Federal Communications Commission. It has two components: the Primary Program provides discounts for monthly connectivity costs and 25% off internet access, while the Pilot Program previously supported up to 85% of costs for building broadband networks. Eligible providers include rural hospitals, clinics, health departments, and mental health centers. The application process involves requesting services, selecting service providers, and notifying the program once services are received to receive discounts.
Meghalaya, a low-income state in India, has faced challenges with inadequate healthcare access. Through a public-private partnership advised by IFC, the state of Meghalaya launched a universal health insurance program. ICICI Lombard General Insurance emerged as the winning bidder to introduce a scheme covering all Meghalaya residents, building upon an existing insurance program for the poor. The new program aims to expand coverage, reduce the financial burden of healthcare, and encourage private sector participation in the state's healthcare system.
The document summarizes key provisions of the Affordable Care Act and how they relate to rural health care. It discusses expanding insurance coverage through Medicaid expansion, health insurance exchanges, and high-risk pools for those with pre-existing conditions. It also addresses improving quality of care through initiatives like accountable care organizations and reducing hospital-acquired conditions and readmissions. Additionally, it outlines provisions to strengthen the rural health infrastructure and workforce, such as National Health Service Corps funding and programs to expand training opportunities.
This document outlines proposals for health, social services, and regional government reforms in Finland. The objectives are to coordinate regional administration, establish an appropriate division of work between different levels of government, implement a client-oriented service system based on county autonomy, and strengthen the sustainability of public finances. Key aspects of the reform include establishing 18 new counties responsible for organizing health and social services, directly electing county councils, transferring over 200,000 employees to counties, establishing regulations and financing for counties, and reducing municipal tax rates while increasing central government taxation to compensate municipalities for transferred responsibilities.
This document summarizes the positions of several Chambers of Commerce in California on ballot initiatives for the November 2016 election. It lists 16 propositions and provides a brief summary for each, including estimated fiscal impacts. The Chambers' positions include support, opposition or no business related (NBR) stance on initiatives related to education funding, healthcare, criminal justice, tobacco and marijuana policies, gun control, death penalty, and the environment.
The document discusses options for maximizing Medicaid enrollment in Maryland under health care reform. It describes how other states and federal programs actively enrolled eligible individuals through proactive strategies like determining eligibility based on existing data sources without requiring applications. Specific policies discussed for Maryland include determining Medicaid eligibility from tax data, limiting application questions to eligibility factors, allowing individuals to request eligibility determinations, basing eligibility on receipt of other benefits, and integrating eligibility across Medicaid and the health insurance exchange. The document argues these strategies can significantly increase enrollment but that affordability still needs to be addressed so low-income individuals will enroll and utilize coverage.
This letter provides guidance to states on implementing a new Medicaid eligibility group established by the Affordable Care Act. It outlines that starting in April 2010, states have the option to cover all non-disabled, non-elderly adults with incomes up to 133% of the federal poverty level. It describes rules for determining income eligibility and required benchmark benefits. States must submit amendments to their Medicaid plans by June 30, 2010 to implement this option starting April 1, 2010.
The document discusses a draft act on clients' freedom of choice for health and social services in Finland. The key points are:
1. The reform aims to ensure equal, modern and affordable health and social services by improving clients' access to care and opportunities to influence the services they use.
2. Under the new system, clients will be able to choose their services from public or private providers registered with the county. They will receive support for their choices from online resources, phone helplines or counselors.
3. Clients' needs and costs are expected to decrease as the population's health and wellbeing is more broadly supported. Higher needs clients will receive more integrated services through assessments, care plans and
Federal Student Aid provides information about the Public Service Loan Forgiveness Program. The program forgives remaining loan balances for borrowers who make 120 monthly payments while working full-time for a qualifying public service employer. Eligible loans include Direct Loans and other federal student loans consolidated into the Direct Loan program. Borrowers must be enrolled in income-driven repayment plans and make payments for 10 years. Qualifying employment includes jobs with government agencies, non-profits, and other organizations providing public services. The first loan balances will be forgiven starting in October 2017 for those meeting the program requirements.
Re-Evaluating Your Managed Care Revenue Improvement Opportunitieschriskalkhof
Within your span of control are:
1) Preparing strategically through internal/external assessments and developing contracting/pricing strategies.
2) Negotiating effectively to optimize reimbursement, payment rules, and contracts.
3) Integrating agreements into revenue management operations through the revenue cycle.
Health Reform Bulletin – Implementation Update: Women’s Preventive Health Se...CBIZ, Inc.
The women’s health services component of the Affordable Care Act’s (ACA) preventive services mandate continues to evolve. As background, the ACA requires non-grandfathered plans to provide specified preventive services at no cost to plan participants. These preventive services require coverage of certain women’s health services including contraceptive coverage. Recent challenges to this requirement have reached the Supreme Court.
Tony Ross, president of United Way of Pennsylvania, gave this presentation as part of the PA Budget Town Hall Meeting held in Scranton, PA on March 9, 2012.
The document summarizes Florida's proposed Medicaid reform plan, which includes shifting Medicaid recipients into private managed care plans through an 1115 waiver approved by the federal government. Key points of concern discussed are that the waiver lacks important operational and budget details, there are questions around how savings will be achieved, and shifting people to managed care does not necessarily reduce costs. Concerns are raised that the proposed reforms could reduce services and shift costs to other groups. The document calls for slowing down approval of the waiver until more details are available to properly evaluate the impact of the proposed changes.
Implementing the Affordable Care Act: Redesigning and Coordinating Eligibilit...NASHP HealthPolicy
The document discusses the challenges states will face in implementing the Affordable Care Act's requirements for coordinating eligibility and enrollment across Medicaid, CHIP, and health insurance exchanges. It notes that Kansas' current eligibility system is outdated and unable to handle the increased load. Kansas plans to use an HRSA grant to build a new integrated online eligibility system that can determine eligibility for Medicaid, subsidies, and private plans in real time. However, many questions around coordination and operational details between state and federal agencies remain unanswered as deadlines approach.
This document summarizes key points from a presentation on rural health issues and healthcare reform. It discusses potential government shutdowns if a budget is not passed, changes to Medicare and Medicaid under the Affordable Care Act, provisions already in effect, and new delivery models like accountable care organizations. Key uncertainties are noted, such as the impact of healthcare reform on rural providers and workforce shortages.
Attorney Michael James spoke to Michigan Association of CPAs yesterday on his presentation "Accountable Care Organizations 2.0". The presentation addressed the hundreds of pages of recently proposed regulations related to ACOs that represent the most dramatic overhaul of the Medicare Shared Savings Program since its inception. Other insights in the presentation:
- Current Regulatory Environment for Integrated Models
- How Environment Evolves Under Proposed Regulations
- Various Requirements Needed for ACOs
- Potential Risks Under Current ACO Models
To learn more, contact attorney Michael James at mjames@fraserlawfirm.com or 517-377-0823. Michael James is a senior attorney at Fraser Trebilcock, providing representation and counseling related to all facets of business enterprise and health care matters.
NOTE: Information contained in this presentation is only current as of the blog publish date. For updated information, refer to the Fraser Trebilcock Health Care Reform blog: fraserlawfirm.com
This document summarizes key provisions of the recently passed US healthcare reform legislation. It outlines major changes occurring between 2010-2014, such as dependent coverage until age 26, elimination of lifetime limits, creation of health insurance exchanges in 2014, and employer penalties for not providing coverage. Administrative impacts are also discussed, such as increased workload from additional required notices and forms. Specific provisions like tax changes, Medicare discounts, and essential health benefits are reviewed.
1. Beginning in 2014, the Affordable Care Act expands Medicaid eligibility and requires states to set up health insurance exchanges to provide subsidized coverage. This large expansion aims to significantly reduce the number of uninsured, including many who have mental health or substance abuse issues.
2. States will receive 100% federal funding from 2014-2016 to support expanding Medicaid eligibility and establishing enrollment systems. They are urged to simplify enrollment processes using online applications and data from other programs to maximize participation in the new coverage options.
3. Community organizations can help with outreach and on-site enrollment assistance, especially for those unfamiliar with public programs. States are encouraged to consider streamlined "Express Lane" eligibility models used successfully in CHIP
The document discusses several provisions in the Affordable Care Act that aim to improve coordination of benefits and care for "dual eligibles" - the nine million individuals who qualify for both Medicare and Medicaid. It outlines changes to Medicare Special Needs Plans, reducing Medicare Part D cost-sharing for some dual eligibles, extending Medicaid waivers, establishing an Office on Coordination of Benefits, and assessing adult services for dual eligibles. The overall goal is to address problems dual eligibles face and reduce confusion caused by the different rules of Medicare and Medicaid.
This document discusses Medicaid managed care and the implications of the Medicaid Managed Care Final Rule. It provides an overview of the growth of Medicaid and managed care within Medicaid. It outlines Aetna's footprint in Medicaid managed care. The main provisions of the Final Rule that impact managed care are summarized, including requirements around actuarial soundness, phasing out of pass-through payments, strengthening network adequacy standards, aligning provider screening and enrollment processes, and standardizing information requirements for enrollees. The document concludes that the Final Rule modernizes Medicaid managed care practices and oversight to be more consistent with Medicare Advantage and Marketplace plans.
CBO provides summaries of its health care analysis methods and recent work. It evaluates health care proposals using a 10-year horizon, examining insurance coverage, health care spending projections, and more. Recent reports analyzed the uninsured, health care prices, and single-payer proposals. CBO also provides cost estimates and scores legislation on issues like surprise billing, the ACA, Medicare expansions, and drug pricing. It describes how it uses modeling, behavior assumptions, and a 10-year window in its analyses.
The Secrets of Massachusetts’ Success: Why 97 Percent of State Residents Have...soder145
The document summarizes a study on how Massachusetts achieved near-universal health insurance coverage through its 2006 health reform law. Key factors in its success were: 1) Using existing data to automatically enroll eligible residents in Medicaid and the new Commonwealth Care program; 2) Creating a single, integrated eligibility system across multiple programs; and 3) Conducting an intensive public education campaign along with grants to community groups for outreach and enrollment assistance. These innovative strategies were highly effective in quickly expanding coverage to over 432,000 newly insured residents in just two years.
The Secrets of Massachusetts’ Success: Why 97 Percent of State Residents Have...soder145
The document summarizes a study on how Massachusetts achieved near-universal health insurance coverage through its 2006 health reform law. Key factors in its success were: 1) Using existing data to automatically enroll eligible residents in Medicaid and the new Commonwealth Care program; 2) Creating a single, integrated eligibility system across multiple programs; and 3) Conducting an intensive public education campaign along with grants to community groups for outreach and enrollment assistance. These innovative strategies were highly effective in quickly enrolling many newly eligible residents at a lower administrative cost than traditional individual applications. Lessons from Massachusetts' model could inform national and state health reform efforts.
The document discusses emerging value-based healthcare payment models in the US and provides recommendations for stakeholders. It outlines recent legislation like MACRA that aims to shift Medicare payments from fee-for-service to value-based models. MACRA establishes the MIPS program which combines existing quality programs and the APM program which incentivizes participation in alternative payment models. It also describes various CMS pay-for-performance programs focused on readmissions, hospital value, and hospital-acquired conditions. The document concludes with recommendations for stakeholders to collaborate across the healthcare system to effectively transition to value-based models.
The document provides instructions for an advocacy report on Medicaid reform for a state that opted out of the Affordable Care Act's Medicaid expansion. Students are asked to recommend either participating in the original expansion or a modified expansion using waivers. The report must describe the state's current Medicaid program, spending/savings since the ACA, and details of pending waivers. It should also benchmark another state's success with the recommended reform strategy. Resources on Medicaid expansion from Commonwealth Fund and Kaiser Family Foundation are provided.
The Patient Protection and Affordable Care Act (PPACA) will bring significant changes to Medicaid and Medicare. Medicaid eligibility will expand to cover more low-income individuals and families. The federal government will provide increased funding to states for the Medicaid expansion. PPACA also enhances Medicare benefits by fully covering annual wellness visits and preventative services with no cost sharing. The Congressional Budget Office estimates PPACA will reduce future Medicare spending and extend the solvency of the Medicare trust fund, but these savings cannot be used to fund other new spending under the law.
Medicaid: What You Need to Know (CSH and Foothold)Ronan Martin
In our first session, Foothold Technology Director of Client Services, Paul Rossi and Senior Advisor, David Bucciferro, along with Sue Augustus from CSH, will bring us back to basics of all things Medicaid. They will cover topics ranging in commonly used terms, coverage and eligibility and the differences between Medicaid and Medicare. This webinar series is designed for beginners and experts alike. Beginners will walk away with a strong foundation and experts will have the opportunity to contribute to the conversation.
The document discusses how the Patient Protection and Affordable Care Act (PPACA) will impact Medicare payments and billing procedures. Key points include:
1) The PPACA establishes annual wellness visits for Medicare beneficiaries starting in 2011 that are not subject to deductibles or coinsurance.
2) Starting in 2011, primary care physicians will receive a 10% bonus on Medicare payments if they bill at least 60% of services as primary care.
3) Claims must now be submitted within one calendar year of the date of service instead of 15 months, effective January 2010.
4) Several other payment increases and changes take effect between 2010-2015, including bonuses for services in underserved areas and an extension
Quality Payment Program (MACRA) Proposed RuleMick Brown
The Quality Payment Program, established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), began in 2017, known as the transition year. The Program’s main goals are to:
Improve health outcomes.
Spend wisely.
Minimize burden of participation.
Be fair and transparent.
The Quality Payment Program has 2 tracks: (1) The Merit-based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).
Because the Quality Payment Program brings significant changes to how clinicians are paid within Medicare, the Centers for Medicare & Medicaid Services (CMS) is continuing to go slow and use stakeholder feedback to find ways to streamline and reduce clinician burden. CMS has engaged more than 100 stakeholder organizations and over 47,000 people since January 1, 2017 to raise awareness, solicit feedback, and help clinicians prepare to participate. Based on stakeholder feedback, CMS established transition year policies from the clinician perspective, such as:
Giving clinicians the option to choose how they’ll participate (also known as Pick Your Pace).
Having a low-volume threshold that exempts many clinicians with a low volume of Medicare
Part B payments or patients.
Allowing flexibilities for clinicians who are considered hospital-based or have limited face-to-
face encounters with patients (referred to as non-patient facing clinicians).
As the Quality Payment Program moves into the second year, CMS wants to ensure that there is meaningful measurement and the opportunity for improved patient outcomes while minimizing burden, improving coordination of care for patients, and supporting a pathway to participation in Advanced APMs.
This document summarizes the reasons for and key aspects of North Carolina's 2001 mental health system reform. The goals of the reform were to increase local control and governance, promote accountability, and shift away from reliance on institutions by increasing community-based services. The reform established Local Management Entities (LMEs) at the county level to oversee services provided by networks of community providers. It also aimed to focus the system on serving those most in need, increase evidence-based practices, and require more consumer and family input. Major challenges of fully implementing the reform included developing community treatment capacity, addressing inadequate funding, and transitioning from the existing institution-focused system.
This document summarizes the changes made to the United States' Federal Strategic Plan to Prevent and End Homelessness (Opening Doors) in its 2015 amendment. Key changes include updating the goal of ending chronic homelessness from 2015 to 2017, clarifying the role of Medicaid in financing permanent supportive housing, and adding strategies around using data to improve homelessness programs and services. The amendment strengthens the original plan by incorporating new evidence and strategies while carrying forward previous changes made in 2012.
This document discusses the meaningful use incentives available through Medicaid and Medicare for eligible professionals and providers who implement and meaningfully use certified electronic health record (EHR) technology. It outlines the goals of meaningful use, who can participate, how the incentive payments work, the requirements and measures, and provides strategies for achieving meaningful use. Examples are given of providers who saved money and increased revenues after implementing EHRs. Contact information is provided for those with additional questions.
This document discusses healthcare reform and the implications for community behavioral health organizations as employers. It provides an overview of the current state of employer-sponsored healthcare coverage and how provisions in the Affordable Care Act will impact employers. Key provisions that will affect employers beginning in 2014 include requiring plans to cover those seeking coverage regardless of pre-existing conditions, eliminating annual limits on coverage, and assessing penalties on employers not offering affordable coverage. The document outlines various insurance market, coverage, and employer requirements that will be implemented between 2010 and 2018 as a result of healthcare reform.
- The document summarizes Avalere Health's responses to various questions about how provisions of the Affordable Care Act (ACA) apply to employers, health plans, and state regulations.
- Key points addressed include: employees can only use Flexible Spending Accounts for prescribed drugs and insulin after 2010; the ACA allows premium discounts up to 30% for wellness programs but states can impose stricter rules; municipalities are considered employers under the ACA; medical loss ratios will be calculated annually but rebates for 2013 will be based on 2011-2013 data; and how provisions apply to partial vs full self-insurance.
This document discusses implications of the Affordable Care Act for community behavioral health organizations as employers. It provides an agenda that will cover the current status of employer-provided health insurance, relevant provisions in the ACA, the impact on employers, retiree benefits, and opportunities and threats. Introductory polls ask about organization size, offering retiree insurance, and considering dropping insurance benefits. The presentation is by Avalere Health experts Bonnie Washington and Eric Hammelman.
Here are the key highlights from the schedule:
- Sunday features preconference programs including one-day universities and a symposium for CEOs and boards.
- Monday kicks off the main conference with general sessions from Linda Rosenberg and Howard Dean in the morning, followed by workshops, thought leader sessions, and a Dance the Night Away reception in the evening.
- Tuesday has general sessions from Malcolm Gladwell and Geoffrey Canada in the morning and afternoon, along with workshops and thought leader sessions throughout the day.
- Wednesday wraps up with a morning general session from Lee Cockerell before closing programs in the afternoon.
- Additional events include film screenings, book signings, the Expo Hall, Wii
The document outlines SAMHSA's strategic initiatives for 2011-2014 to guide its work in reducing the impact of substance abuse and mental illness. It identifies 8 strategic initiatives: 1) Prevention of substance abuse and mental illness, 2) Trauma and justice, 3) Military families, 4) Health care reform implementation, 5) Housing and homelessness, 6) Health information technology, 7) Data, outcomes, and quality, and 8) Public awareness and support. The initiatives aim to make behavioral health an essential part of overall health, demonstrate that prevention and treatment are effective, and promote recovery from mental and substance use disorders.
Here are some tips for getting answers to insurance-related questions:
- Contact your health insurance provider directly. Call the customer service number on the back of your insurance card and ask to speak to a representative. Have your policy number and specific questions ready.
- Check your plan documents. Your insurance provider should have given you documents that outline what is and isn't covered by your plan. Refer to these documents to see if they address your specific question.
- Contact your state's department of insurance. State departments of insurance regulate health insurers and can help answer questions or investigate complaints. You can find contact info on their website.
- Talk to your employer's benefits administrator. If you get insurance through your job, your
This document announces a Notice of Funding Availability (NOFA) from the Department of Housing and Urban Development (HUD) for the Continuum of Care Homeless Assistance Program. Approximately $1.68 billion is available in fiscal year 2010 funding to reduce homelessness through assisting individuals and families to obtain housing and self-sufficiency. Eligible applicants include Continuums of Care that coordinate housing and services for homeless populations. The application deadline is November 18, 2010 and applications must be submitted through HUD's electronic grants management portal.
The Robert Wood Johnson Foundation is accepting nominations for their Community Health Leaders award program through October 22, 2010. The program will select up to 10 individuals to receive $125,000 awards to recognize their work improving health in underserved communities. Nominees must demonstrate leadership in community health, innovation, impact, and resilience. The awards support the individual leader and a 2-year project at their organization to further their work.
The Consortium for Citizens with Disabilities (CCD) submitted comments on interim final rules implementing provisions of the Affordable Care Act regarding coverage of preventive services. CCD supports coverage of preventive services without cost sharing but believes rules should be strengthened. CCD recommends expanding the definition of preventive services and medical necessity to include maintenance of function. CCD also recommends clarifying coverage for high risk populations and services not addressed by guidelines. Stronger monitoring and enforcement of rules is needed.
The document is a letter from the Coalition for Whole Health commenting on interim final rules for group health plans and health insurers relating to coverage of preventive services under the Affordable Care Act. The coalition supports the goals of healthcare reform and access to mental health and addiction services. They ask that the final rules: 1) explicitly recognize covered preventive mental health and substance use services and ensure primary care professionals receive training, 2) encourage consideration of additional effective preventive services, and 3) revise provisions that could disproportionately burden access to services for those with mental health/substance use disorders.
The Consortium for Citizens with Disabilities (CCD) submitted comments on interim final rules implementing provisions of the Affordable Care Act regarding coverage of preventive services. CCD supports coverage of preventive services without cost sharing but believes rules should be strengthened. CCD recommends expanding the definition of preventive services and medical necessity to include maintenance of function. CCD also recommends clarifying coverage for high risk populations and services not addressed by guidelines. Stronger monitoring and enforcement of rules is needed.
Linda Rosenberg, President and CEO of the National Council for Community Behavioral Healthcare, discusses the increased demand community mental health centers will face under healthcare reform and the Affordable Care Act. An estimated 1.5 million new patients will enter treatment, increasing caseloads by over 20%. However, cuts to public mental health services have also occurred. She asks Congress to support the Community Mental Health and Addiction Safety Net Equity Act to provide reimbursement parity for community behavioral health centers. She also asks Congress to ensure people with mental illness can benefit from provisions in the Affordable Care Act, including its Health Home State Option, and receive equal access to health information technology.
The Secretary of Health and Human Services sent a letter to governors highlighting new opportunities in the Affordable Care Act to support people with disabilities. The Act expands Medicaid coverage starting in 2014 and provides funding to strengthen home- and community-based services. It also extends the Money Follows the Person program to help more people transition from institutional to community living. The Secretary encourages governors to take advantage of these provisions to improve healthcare access and adherence to the Americans with Disabilities Act.
The National Council for Community Behavioral Healthcare provided feedback on SAMHSA's position paper describing a modern mental health and addiction treatment system. They suggested that the proposed continuum of care be more specific and evidence-based. They also recommended shortening the introductory section and strengthening the evidence for interventions. Establishing federally qualified behavioral health centers would help implement SAMHSA's vision by standardizing services, collecting outcome data, and bringing funding predictability.
The letter urges the National Commission on Fiscal Responsibility and Reform to take a balanced approach to deficit reduction by both reducing spending and raising revenue. It argues that disproportionate cuts to nondefense discretionary programs, which fund health, education, and social services, would immeasurably harm vulnerable Americans and undermine the nation's competitiveness, despite comprising a small portion of the budget. The letter is signed by over 120 organizations concerned with health, education, poverty, and civil rights.
The National Council for Community Behavioral Healthcare submitted comments in response to interim final regulations for internal claims and appeals processes and external review. The National Council represents over 1,700 community mental health and addiction treatment providers. They urged the Departments to (1) increase transparency in health plan decision making, (2) reduce barriers to the appeals process, and (3) provide support to state regulators to ensure enforcement of consumer protections.
This document is the July 2008 issue of the National Council Magazine. It focuses on veterans returning from Iraq and Afghanistan and their road home.
The issue includes:
- An editorial highlighting the mental health and addiction issues facing many veterans and how community organizations are well-suited to help veterans reintegrate into civilian life.
- Statistics about the high rates of PTSD, depression, substance abuse and homelessness among veterans.
- First-hand accounts from veterans discussing their experiences and struggles.
- Case studies of programs around the country that are helping to meet veterans' behavioral healthcare needs through community partnerships and innovative approaches.
Nearly 40% of soldiers returning from Iraq and Afghanistan report mental health issues. The document discusses two main organizations that provide mental health services to veterans and active military - the Veterans Health Administration (VA) and TRICARE. The VA is the largest integrated health system for veterans and offers various inpatient and outpatient services. TRICARE is the health program for active and retired military personnel and their families. It discusses how behavioral health professionals can become TRICARE providers to expand access to services for beneficiaries.
Nearly 40% of soldiers returning from Iraq and Afghanistan report mental health issues. The document discusses two main organizations that provide mental health services to veterans and active military - the VA and TRICARE. It outlines eligibility requirements and services provided by each, such as outpatient counseling and inpatient care. It also discusses ways for community providers to become part of these networks to increase access to care for veterans dealing with conditions like PTSD and substance abuse.
Mh and addiction services for service members and veterans
Smd10012
1. DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Medicare & Medicaid Services
7500 Security Boulevard, Mail Stop S2-26-12
Baltimore, Maryland 21244-1850
Center for Medicaid, CHIP, and Survey & Certification
SMDL# 10-012
ACA# 3
June 22, 2010
RE: Extension of the Money Follows the Person
Rebalancing Demonstration Program
Dear State Medicaid Director:
On March 23, 2010, President Obama signed into law the Patient Protection and Affordable Care
Act (the Affordable Care Act), Pub. L. No. 111-148. This landmark legislation includes several
provisions addressing the needs of people living with disabilities and elderly individuals who
require long-term care, including the extension of the Money Follows the Person Rebalancing
(MFP) Demonstration Program for an additional 5 years (the funding was scheduled to expire at
the end of FY 2011). The extension of the MFP Demonstration Program through 2016 offers
States substantial resources and additional program flexibilities to remove barriers and improve
people’s access to community supports and independent living arrangements.
This letter provides background about the MFP Demonstration Program, explains improvements
made by the Affordable Care Act, details how the Affordable Care Act will impact current MFP
grantees, and provides preliminary information for non-participating States that may be
interested in pursuing new funding. As discussed in our letter of May 20, 2010, the MFP
Demonstration Program is an important tool States can use to make greater progress in achieving
the promise of the ADA and Olmstead. That letter is available at
http://www.cms.gov/smdl/downloads/SMD10008.pdf
Background
The MFP Rebalancing Demonstration Program provides assistance to States to balance their
long-term care systems and help Medicaid enrollees transition from institutions to the
community. The MFP Demonstration Program, authorized by Congress in section 6071 of the
Deficit Reduction Act of 2005 (DRA), is designed to help States shift Medicaid’s long-term care
spending from institutional care to home- and community-based services (HCBS). Congress
initially authorized up to $1.75 billion in Federal funds through fiscal year (FY) 2011 to:
1) Increase the use of HCBS and reduce the use of institutionally-based services;
2) Eliminate barriers and mechanisms in State law, State Medicaid plans, or State budgets that
prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals
to receive long-term care in the settings of their choice;
3) Strengthen the ability of Medicaid programs to assure continued provision of HCBS to those
individuals who choose to transition from institutions; and,
4) Ensure that procedures are in place to provide quality assurance and continuous quality
improvement of HCBS.
2. Page 2 – State Medicaid Director
The MFP Demonstration Program offers an enhanced Federal Medical Assistance Percentage
(FMAP), as well as significant financial resources, to support the administration of the
demonstration and implementation of broader infrastructure investments. These investments
include initiatives such as: creating systems for performance improvement and quality assurance,
developing housing initiatives, supporting staff for key transition activities, improving the direct
care workforce, and building “no wrong door” access to care systems.
Currently, twenty-nine States and the District of Columbia have implemented MFP
Demonstration Programs. After a pre-implementation period, States began actively transitioning
individuals into community settings in the spring of 2008. Since the beginning of calendar year
2009, the number of participants transitioning has increased as solutions to barriers were
identified and significant technical assistance is continuing to be provided to help States meet
transition benchmarks they set. As of December 2009, almost 6,000 individuals have returned to
the community as a result of these demonstrations.
Advantages to Participating States
This section reviews some of the benefits to States of participating in the MFP Demonstration
Program, including opportunities to develop unique home and community-based demonstration
services to help individuals make the transition from institutional care to quality, person-centered
services in the home:
Enhanced FMAP: The MFP Demonstration Program provides an enhanced FMAP rate for
qualified services, which include HCBS services and demonstration services. This rate is equal
to taking the published FMAP for a State, subtracting it from 100 percent, and dividing the total
by half, and adding that percentage to the published FMAP. As an example, a State that
normally has a 50 percent FMAP will have a 75 percent FMAP under MFP. The enhanced MFP
FMAP cannot exceed 90 percent. The enhanced rate is available for qualified services provided
to an MFP participant for 365 days after transition from an institution.
Increased FMAP through December 31, 2010: The American Recovery and Reinvestment Act
of 2009 (Recovery Act) provides States an increased FMAP from October 1, 2008 through
December 31, 2010. CMS will use the applicable Recovery Act increased FMAP as the base
from which to calculate States’ MFP-enhanced FMAP rate each quarter during this period,
subject to a 90 percent cap. To illustrate, if a State’s regular FMAP rate is 50 percent, and is 62
percent under the Recovery Act, then the MFP enhanced rate would be 81 percent (rather than 75
percent, as in the example above). The resulting enhanced MFP FMAP rate cannot exceed 90
percent.
National Technical Assistance (TA): CMS has contracted with experts in the long-term care
field to assist grantees, at no cost to the State, by providing the support and expertise necessary
to enable the States to work through problems and barriers to implementation. The TA
providers, along with support from the CMS Project Officers and Regional Office Analysts, are
available to ensure success.
HCBS and Demonstration Services: HCBS and demonstration services are reimbursed at the
enhanced MFP FMAP. Qualified HCBS services are HCBS waiver services that will continue
3. Page 3 – State Medicaid Director
once the MFP Demonstration Program has ended. Demonstration services are services that can
be covered under Medicaid and that will only be billed to grant funding during an individual’s
12-month transition period. After the demonstration period, the State is not obligated to continue
the demonstration services, but may choose to fund them through Medicaid for eligible
individuals, or through other funding streams.
Supplemental Services: Reimbursement is provided for services that will only be available for
the MFP Demonstration Program period and are not covered by Medicaid. These services are
reimbursed at the State’s published FMAP (which includes the increased FMAP during the
Recovery Act period).
Full Reimbursement for Specific Administrative Costs: Reimbursement associated with the
operation of the MFP grant may be provided after the submission, review, and approval of the
grant application’s Operational Protocol. Examples of eligible reimbursable items that may be
considered in a State application’s Operational Protocols are: key personnel; MFP travel,
training, outreach and marketing; IT infrastructure to accommodate the MFP reporting
requirements; and completing the Quality of Life survey requirements.
The Affordable Care Act
Section 2403 of the Affordable Care Act (ACA), titled “Money Follows the Person Rebalancing
Demonstration,” provides an opportunity for those States that are presently participating in the
program to continue building and strengthening their MFP Demonstration Programs and for
additional States to participate. The law amends section 6071 of the DRA to make the following
changes:
1) Extends the MFP Demonstration Program through September 30, 2016, and appropriates an
additional $450 million for each FY 2012-2016, totaling an additional $2.25 billion. Any
remaining MFP appropriation at the end of each FY carries over to subsequent FYs and is
available to make grant awards to current and new grantees until FY 2016. Grant awards
shall be made available to the State for the FY in which the award was received and for
additional FYs. As such, any unused portion of a State grant award made in 2016 would be
available to the State until 2020.
2) Expands the definition of who may be eligible for the demonstration. Under the DRA, only
those individuals who resided in a qualified institution for more than 6 months were eligible
to participate in the MFP Demonstration Program. For these individuals, the increased
FMAP to the State for HCBS is available up to 365 days after the individual transitions from
an institution to the community.
Under the Affordable Care Act, individuals that reside in an institution for more than 90
consecutive days are now eligible to participate in the demonstration. However, one
exception applies in the expanded definition of eligibility: days that an individual was
residing in the institution for the sole purpose of receiving short-term rehabilitation services
that are reimbursed under Medicare are excluded and will not be counted toward the 90-day
required period. On May 17, 2010, CMS issued additional policy guidance to existing
4. Page 4 – State Medicaid Director
grantees regarding the criteria, detailed in the grant solicitation, that should be used to
determine the applicability of the new 90-day exclusion.
3) Additional funding is provided through 2016 for the National MFP Evaluation. The
Affordable Care Act extends the DRA provision that a maximum of $1.1 million per year
shall be available for research and evaluation purposes and is part of the $2.25 billion total
noted above.
What This Means for Current Grantees
The current MFP Demonstration Programs will experience a seamless transition into the next 5
years of the Demonstration authorized under the Affordable Care Act. CMS will not require
currently participating States to compete again through a new solicitation process. States will
only need to submit a written request to the CMS Grants Office in the summer of 2011 for
continued participation in the MFP grant program. All current MFP grantees may continue to
operate their programs within their approved Operational Protocols, and, in response to annual
budget requests, CMS will make supplemental grant awards through 2016. However, given the
program extension, additional funding, and added program flexibility provided by the Affordable
Care Act, we expect and encourage current grantees to explore immediately – in consultation
with CMS – opportunities to modify, extend, and expand their existing programs.
MFP Grants May Be Awarded to States Not Currently Participating
CMS will post a grant solicitation in late July to www.grants.gov to offer States not currently
participating the opportunity to apply for an MFP Demonstration Program Grant through a
competitive award process. Early in the solicitation process, CMS will provide States with
specifications for developing the grant application. Assistance to interested States will be
provided via State/applicant calls and Webinar briefings. If awarded a grant, the State’s
application will become the Operational Protocol for program implementation, enabling the State
to begin transitioning individuals soon after the award. After the posting to www.grants.gov,
States will have 120 days to develop and submit the MFP application.
Extension of the MFP Demonstration Program and funding is an important outcome of the
Affordable Care Act for thousands of persons living with disabilities and elderly individuals who
are unable to secure the support they need to achieve their choice of community living. For
participating States, the extension of the program with additional funding is an opportunity for
States to continue to expand MFP Demonstration Programs and to make significant progress in
rebalancing their long-term care systems. For those States now eligible to apply for a new MFP
Rebalancing Demonstration Program, it is a unique opportunity to give many individuals, now
living in institutions across this nation, the choice to live and receive long-term care services in
their homes and communities.
5. Page 5 – State Medicaid Director
We hope you will find this information helpful. Questions regarding the MFP Demonstration
Program may be directed to Ms. Barbara Edwards, Director, Disabled and Elderly Health
Programs Group at 410-786-7089.
Sincerely,
/s/
Cindy Mann
Director
cc:
CMS Regional Administrators
CMS Associate Regional Administrators
Division of Medicaid and Children’s Health
Ann C. Kohler
NASMD Executive Director
American Public Human Services Association
Joy Wilson
Director, Health Committee
National Conference of State Legislatures
Matt Salo
Director of Health Legislation
National Governors Association
Debra Miller
Director for Health Policy
Council of State Governments
Christine Evans, M.P.H.
Director, Government Relations
Association of State and Territorial Health Officials
Alan R. Weil, J.D., M.P.P.
Executive Director
National Academy for State Health Policy