Deficit Reduction Act (DRA)

<i>NOTE: The effective date for this rule has been postponed to April 3, 2009 and the comment period has been reopened, pending review by the Obama administration. See "Interim Rule" below.</i> CMS issued a Final Rule giving states the flexibility to define the scope of medical assistance covered by Medicaid by offering coverage of benchmark or benchmark-equivalent benefit packages to certain recipients. The file contains the official text of the rule as entered into the Federal Registry.

Recessions deliver a one-two punch to Medicaid by undercutting available public funds and increasing demand for services. This policy brief presents several options for strengthening Medicaid during these periods. Options outlined include: directing federal funding support; quickly reauthorizing SCHIP; simplifying enrollment; easing burdens imposed by the process of proving citizenship; and expanding coverage to those hit hardest by recession.

This report analyzes Alaska’s LTC system and makes recommendations for reform. The report provides a discussion of the opportunities and challenges of the various Medicaid authorities for funding LTC, including new DRA options. Recommendations include establishing mechanisms for controlling costs; streamlining access and coordinating assessment processes; developing a quality management strategy that complies with CMS requirements; and increasing consumer direction.

This report provides a summary of how long-term services and supports (LTSS) are financed and describes factors that contribute to uncertainty of the future costs for LTSS, including changes in how LTSS will be delivered. Three projections of future LTSS spending for senior populations under different scenarios are offered. These scenarios differ based on projecting the number of people with varying functional limitations and the resulting need for varying degrees of LTSS.

A final rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services directed by an agency, was published in the Oct 3, 2008 Federal Register. The rule, effective Nov. 3, 2008, guides states that wish to allow beneficiaries who need help with activities of daily living to hire, direct, train or fire their own personal care, workers including qualified family members.

This paper examines the use of research, demonstration, and program waivers as vehicles for innovation in the delivery and payment of health care and long-term care. It summarizes the context of the creation of the programs and reviews their legal underpinnings. It also analyzes the dynamics between state and federal authorities. Finally, the paper examines the impact of the Deficit Reduction Act of 2005 on the need for or desirability of waivers.

This report and the accompanying tables summarize ways in which states have implemented optional Medicaid programs authorized by the Deficit Reduction Act of 2005 (DRA). Each section of the report explains a program states have the option of implementing, which states did so, and how these changes affect people with mental disorders. The tables illustrate key characteristics of the programs in each participating state.

This issue brief reviews how new rules issued by CMS governing Medicaid coverage of targeted case management (TCM) services would affect people with complex health needs receiving home and community-based services. The author finds that the availability of several important services and strategies used in TCM would be significantly reduced. New record keeping requirements would also increase administrative burdens and costs.

CMS has proposed rule changes to implement Section 1915(i) of the Social Security Act. 1915(i) enables states to provide a prescribed set of HCBS to individuals that earn less than 150% of the Federal Poverty Level and require less than institutional levels of care. It does so without requiring waivers (as in 1915(c)), consumer eligibility for institutional care, or a cost savings demonstration. Further background information and instructions for comment submission are included.

The Deficit Reduction Act (DRA) of 2005 clarified which case management and targeted case management services are covered by Medicaid. The rule addresses concerns about improper billing of non-Medicaid services to the program by some states, while aiming to ensure comprehensive services that meet the needs of beneficiaries. These documents from CMS are meant to assist practitioners in understanding and abiding by these rules.