Affordable Care Act (ACA)

In its first year of operation, the Center for Medicare and Medicaid Innovation has a long list of accomplishments, yet some observers express concern that its fast-paced approach may be overwhelming to smaller delivery systems. A status report of the Innovation Center’s activities to date is provided, including delineating the goals envisioned by Congress, detailing the new tools it was given, and emphasizing how the enhanced authority compares with CMS’ traditional demonstration programs.

Overview provided about individuals and families who can be expected to receive assistance under insurance affordability programs, which include Medicaid, CHIP, advance premium tax credits and cost-sharing reductions, and Basic Health Programs. Particular focus is placed on the characteristics of individuals whose incomes place them at or near the Medicaid/exchange dividing line. The authors identify opportunities for greater collaboration and alignment in key areas.

This site offers a wealth of information for anyone seeking clarification about the Balancing Incentive Program. It also provides numerous resources States will find useful when pursuing the benefits offered by the Program, including: The Program Application; The Implementation Manual; A user-friendly Work Plan; A user-friendly CSA/CDS crosswalk; Frequently Asked Questions; Webinars; Additional resources on the web; and beyond.

The Affordable Care Act requires the Office of Inspector General to submit a report to Congress evaluating the law’s Nationwide Program for National & State Background Checks on Direct Patient Access Employees of Long Term-Care (LTC) Facilities within six months of the program’s completion. OIG recently conducted a survey of LTC provider administrators, & asked them about current practices regarding background checks on potential employees, & the effects of such programs on the LTC workforce.

The Administration on Aging (AoA) has a new page on its website that highlights program and funding opportunities within the Affordable Care Act that relate to the mission and vision of AoA and the Aging Network. Topics covered include Medicare and Medicaid, prevention, and webinars and technical assistance resources.

Many states are undergoing long-term services & supports (LTSS) transformations. The lagging economy & increased demand for publicly funded LTSS are placing pressure on state policymakers to find solutions. As a result, many states either have or plan to implement Medicaid Managed LTSS, with 12 states having existing programs & another 11 with plans for implementation. Many states used the economic downturn as an opportunity to balance services from institutional to non-institutional settings.

Despite continued fiscal pressures on states, eligibility policies remained stable in nearly all state Medicaid and Children's Health Insurance Programs during 2011. Moreover, many states used technology to increase program efficiency and streamline enrollment. The "maintenance of eligibility" requirement in the Affordable Care Act (ACA) played a key role in preserving coverage levels. Without it, more states likely would have limited eligibility or tightened enrollment procedures.

This bulletin provides information that CMS hopes will be helpful to States as they work to implement section 3309 of the Affordable Care Act which eliminates Part D cost-sharing for full benefit dual eligible individuals receiving home and community-based services. The effective date for Section 3309 is January 1, 2012.

This bulletin clarifies earlier guidance the Centers for Medicare & Medicaid Services provided in a May 31, 2011 Informational Bulletin and accompanying Frequently Asked Questions on section 6501 of the Patient Protection and Affordable Care Act (ACA). Section 6501 of the ACA amends a section of the Social Security Act and requires State Medicaid agencies to terminate the participation of any individual or entity if terminated under Medicare or any other State Medicaid plan.

State aging & disability agencies are operating in an era of state agency reorganization, re-conceptualization of state government, & restructuring of long-term services & supports delivery systems & financing. Key elements driving continued change include the economic environment, ACA implementation, uncertainty in the federal budget particularly with the failure of the Congressional Super Committee, changes in state level leadership, & the 2012 elections.