Medical Assistance Program Oversight CouncilMarch 14, 2014

Today’s Agenda

Affordable Care Act “report card”

2

Affordable Care Act Report Card

33

Affordable Care Act (ACA) mandatory provisions:

Primary care rate increases Ordering, Prescribing and Referring (OPR) provider

enrollment requirements Reduction in Disproportionate Share Payments

(DSH) Transformed Medicaid Statistical Information System

(T-MSIS)

Affordable Care Act Report Card (cont.)

44

ACA optional provisions:

Expansion of eligibility Medicaid coverage of tobacco cessationMedicaid coverage of family planning servicesState Balancing Incentive Payments ProgramMoney Follows the Person (MFP) expansion

ACA Mandates: Primary Care Rate Increase

55

Section Description Grade

Increase in Primary Care Rates

Section 1202

ACA requires that Medicaid increase payments to eligible primary care providers for a range of identified codes to the Medicare rate for calendar years 2013 and 2014. This involved negotiating and obtaining CMS approval of a Medicaid State Plan Amendment, working with various interested providers and associations, and establishing a process through which providers could attest to their eligibility, and retrospective adjustment of payments back to January 1, 2013.

A+

Fully implemented!

ACA Mandates: OPR

66

Section Description Grade

Ordering, Prescribing and Referring provider enrollment requirements

Sections 6401 and 6501

ACA requires that all ordering, prescribing and referring providers enroll individually in Medicaid. This also involved diverse implementation steps, including implementation of a streamlined, short-form, electronic OPR-only enrollment process; development of bulletins and FAQ documents development and implementation of consumer protections for pharmacy, and partnerships with the ASOs and with various provider associations to educate providers and to resolve concerns.

A+

Fully Implemented!

ACA Mandates: Reduction in DSH

77

Section Description Grade

Reduction in Medicaid Disproportionate Share (DSH) payments to hospitals

Because the number of uninsured individuals is expected to drop due to the eligibility expansion under ACA, the law reduces DSH funding over time.

A

Fully Implemented!

ACA Mandates: Reduction in T-MSIS

88

Section Description Grade

Transformed Medicaid Statistical Information System (T-MSIS)

Section 6504

MSIS is an extract of States’ Medicaid Management Information Systems (MMIS) and contains claims information from all 50 States and the District of Columbia.  MSIS is composed of an eligibility file and there are four claims files (inpatient, long-term care, pharmacy, and other). CMS’s efforts to improve MSIS will result in a new national Medicaid dataset called T-MSIS. Among CMS’s goals for T-MSIS are improving the completeness, accuracy, and timeliness of the data.

In process for July 1,

2014 deadline!

ACA Options: Expansion of Eligibility

99

Section Description Grade

Section Consistent with a decision of the Supreme Court, states have the option to expand eligibility for identified coverage groups to 138% of the FPL. Under ACA, DSS expanded Medicaid eligibility for HUSKY D/low-income adults (who were eligible under “early expansion” up to 54% of the Federal Poverty Level (FPL) in Regions B and C and 66% of FPL in Region A), to 138% of FPL beginning January 1, 2014.

A-

Near to completion!

ACA Options: Tobacco Cessation

1010

Section Description Grade

Section ACA requires comprehensive tobacco services (counseling, treatment, and medications including over-the-counter nicotine replacement products) to be provided to all pregnant women covered by the Medicaid Program.

ACA requires that Medicaid programs include tobacco cessation products (as well as barbituates and benzodiazapines, which CMAP already covered) as covered services.

A-

Implemented three weeks

after deadline

A+

Implemented one year in advance of

deadline

ACA Options: Family Planning

1111

Section Description Grade

State option for Family Planning Services

Section 2303

Under this section, Federal funding enables States to provide eligible men and women with Medicaid State Plan coverage of family planning and family planning-related services and supplies. Before ACA, States’ only option was to offer these services through demonstration projects.

A+

Fully Implemented!

ACA Options: BIPP

1212

Section Description Grade

State Balancing Incentive Payments Program (BIPP)

Section 10202

ACA established this program to incent states to shift further resources to home and community-based long-term services and supports (LTSS). States that spent 25-50% on non-institutionally-based LTSS in 2009 are eligible for a 2% enhanced FMAP. These States must reach 50% of total LTSS expenditures on non-institutionally based LTSS by September 30, 2015. MFP led efforts to submit Connecticut’s application for BIPP funding.

A+Received

$72.8 million in funding and in process on re-balancing

goal

ACA Options: MFP Expansion

1313

Section Description Grade

Money Follows the Person (MFP) expansion

Section 2403

ACA also:

•extends the MFP Program through September 30, 2016, and appropriates an additional $2.25 billion ($450 million for each FY 2012-2016); and•expands the definition of who's eligible to include people that live in an institution for more than 90 consecutive days (reduced from 180 days)

A

Fully Implemented!

Questions or comments?

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