affordable care act (aca) the affordable care act

16
Affordable Care Act (ACA) The Affordable Care Act www.dpw.state.pa.us

Upload: derek-houston

Post on 25-Dec-2015

225 views

Category:

Documents


2 download

TRANSCRIPT

Page 1: Affordable Care Act (ACA) The Affordable Care Act

Affordable Care Act (ACA)

The Affordable Care Act www.dpw.state.pa.us

Page 2: Affordable Care Act (ACA) The Affordable Care Act

What is the Affordable Care Act?

Patient Protection and Affordable Care Act (PPACA), a.k.a. ACA

– Federal health care reform law– March 23, 2010 signed into law by President

Obama– Goals:

• Expand coverage• Control health care costs• Improve health care delivery system

2The Affordable Care Act www.dpw.state.pa.us

Page 3: Affordable Care Act (ACA) The Affordable Care Act

What does it do?

• Requires coverage regardless of pre-existing conditions or gender

• Intended to increase rate of individuals covered by insurance through:– Creation of insurance exchanges and

expansion of Medicaid eligibility– Mandates on employers and individuals– Premium subsidies– Tax credits

• Intended to decrease number of uninsured individuals

3The Affordable Care Act www.dpw.state.pa.us

Page 4: Affordable Care Act (ACA) The Affordable Care Act

What does it establish?

• Facilitates provision of qualified health coverage

• Mandates health benefit exchanges (also known as Marketplaces) by January 2014 in every state

• Regulatory overhaul of the U.S. healthcare system

4The Affordable Care Act www.dpw.state.pa.us

Page 5: Affordable Care Act (ACA) The Affordable Care Act

State Requirements – Insurance Exchanges

• Choose an Insurance Exchange Option by December 14, 2012• 3 options:

5The Affordable Care Act www.dpw.state.pa.us

Page 6: Affordable Care Act (ACA) The Affordable Care Act

What role will be played by the FFM?

• The federally facilitated exchange is also referred to as the FFE or federally facilitated marketplace (FFM).

• Individuals may apply for insurance through the Exchange.

• The Exchange will determine eligibility for:– Advanced Premium Tax Credit (APTC)– Cost Sharing Reductions (CSR)

6The Affordable Care Act www.dpw.state.pa.us

Page 7: Affordable Care Act (ACA) The Affordable Care Act

What are APTC and CSR?

Advance Premium Tax Credit (APTC): A new tax credit to help individuals and families afford health coverage purchased through the Exchange.

Cost Sharing Reduction (CSR): A discount that lowers the amount paid out-of-pocket for deductibles, coinsurance, and copayments.

7The Affordable Care Act www.dpw.state.pa.us

Page 8: Affordable Care Act (ACA) The Affordable Care Act

How does ACA affect DPW?

What Has DPW Already Done Related to ACA?

•Extended Medicaid Drug Rebates to drugs paid by Medicaid Managed Care Organizations.

•Implemented several new program integrity and provider enrollment screening processes.

•Began paying increased payments to Medicaid primary care providers.

•Implemented a recovery audit contract to identify payment issues and recoup overpayments.

•Implemented payment policies for hospitals that prohibited payment for a Health-Care Acquired Condition, such as infections acquired at the hospital.

8The Affordable Care Act www.dpw.state.pa.us

Page 9: Affordable Care Act (ACA) The Affordable Care Act

How does ACA affect DPW?

One goal of ACA is to provide a seamless and simplified enrollment process for all Insurance Affordability programs. Pennsylvania will accomplish this requirement for simplified enrollment by providing multiple ways to apply, including:•Exchange

– Electronic Application– Paper Application

•New Pennsylvania paper application form called the PA 600HC•COMPASS – Updated to comply with ACA•Phone Applications

There is ‘no wrong door’ when

applying for Medical Assistance

and other Health Care Plans!

9The Affordable Care Act www.dpw.state.pa.us

Page 10: Affordable Care Act (ACA) The Affordable Care Act

How does ACA affect DPW?

• The Modified Adjusted Gross Income (MAGI) standard will now be used for Medicaid eligibility.– MAGI will apply to adults, children, pregnant

women, parents, caretaker relatives, and individuals eligible for family planning services.

– MAGI does NOT apply to SSI recipients; children in foster care; individuals eligible based on being aged, blind, or disabled; working disabled; or individuals in a facility/eligible for home and community based care.

10The Affordable Care Act www.dpw.state.pa.us

Page 11: Affordable Care Act (ACA) The Affordable Care Act

What is Early MAGI?

• PA applied for an Early MAGI waiver to start MAGI October 1, 2013 rather than January 1, 2014.

• Early MAGI will increase efficiency and reduce duplicative processes in the County Assistance Offices.

11The Affordable Care Act www.dpw.state.pa.us

Page 12: Affordable Care Act (ACA) The Affordable Care Act

How does ACA affect DPW?

• Medicaid Eligibility Changes:–Children ages 6-18 - Income up to 133% of Federal Poverty Level (FPL)–Former foster care children up to age 26

• ACA will NOT change eligibility or benefits for our waiver programs for individuals with physical and intellectual disabilities.

12The Affordable Care Act www.dpw.state.pa.us

Page 13: Affordable Care Act (ACA) The Affordable Care Act

System Updates and Enhancements

• COMPASS– System design, screening, eligibility questions and

routing– Ability to link to Federal Exchange– Ability to obtain information from data matches in

“real time”

• CIS/eCIS/PROMISe– Medicaid eligibility rules under ACA– System design and screen changes

13The Affordable Care Act www.dpw.state.pa.us

Page 14: Affordable Care Act (ACA) The Affordable Care Act

Consumer Service Center (CSC)

• The Commonwealth has taken steps to ensure that the needs of its citizens are met under the new Federal ACA mandate.

• CMS mandates the availability of a call center to take applications on the phone for ACA.

• The CSC opened on October 1, 2013 to answer questions about ACA and take COMPASS applications for health care only.

14The Affordable Care Act www.dpw.state.pa.us

Page 15: Affordable Care Act (ACA) The Affordable Care Act

Critical Milestones

• October 2013•Enrollment applications under the new Modified Adjusted Gross Income (MAGI) eligibility rules begin to be accepted

• January 2014•Exchange coverage begins for Pennsylvania

15The Affordable Care Act www.dpw.state.pa.us

Page 16: Affordable Care Act (ACA) The Affordable Care Act

Questions and Comments

More information on Pennsylvania’s implementation of the Affordable Care Act is

available at www.dpw.state.pa.us.

16The Affordable Care Act www.dpw.state.pa.us