All States/Territories

Check to ensure that your providers are eligible to receive Medicaid funds. Bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions and default on Health Education Assistance Loans. States cannot be reimbursed with Federal Medicaid dollars for any item or service furnished, ordered, or prescribed by individuals or entities on this list. Further, no payment will be made for services or products from providers that employ someone on this list.

CMS offers guidance to states on how to avoid payments to excluded entities and the consequences of failing to prevent these payments. The letter stresses that it is the states’ responsibility to clearly communicate to providers that it is their obligation to screen employees and contractors for exclusion prior to hiring or contracting. It also provides the location of the List of Excluded Individuals/Entities which can be used to prevent improper payment.

This issue brief focuses on the special needs population of dual eligible’s as defined in the Special Needs Plan (SNP), a type of Medicare Advantage plan created by the Medicare Modernization Act of 2003 (MMA). The brief concludes how the SNP has failed this population and offers recommendations for improving dual-eligible SNPs’ prospects.

This document is from a poster session and it illustrates and explains "the Hilltop Crossover Framework" in relation to the coordination of Medicare and Medicaid services to those who are dually eligible. This framework outlines how these services and costs are related.

The Congressional Budget Office examines the likely effects on federal spending of 115 health care reform options. Ch. 8 covers proposals on financing Medicaid and SCHIP and Ch. 10 covers long-term care options. HCBS-related options include: allowing all states to offer HCBS via Medicaid state plan amendments (#99); making HCBS a mandatory benefit (#100); and adjusting federal match rates to favor HCBS over nursing homes (#101). Also included is a presentation on the findings of the report.

The purpose of this study is to synthesize data on the impact that the Rehabilitation Act has had on the employment and post secondary education outcomes of eligible youth. It examines how well existing vocational rehabilitation (VR) structures deliver effective transition services. It also looks at the effectiveness of collaboration between VR, education, and other service systems. Finally, 11 recommendations for the U.S. Congress and various relevant federal and state agencies are given.

<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.

The narrator interviews proponents, staff, and consumers of the Green House model. During visits to two Green Houses for people with Alzheimer’s in Texas, she discusses costs, outcomes, terminology, and guiding principles. According to the interviews, outcomes such as consumer satisfaction and well-being and employee retention and interaction are better than in institutional settings. The 11 minute audio file is part of the “New Directions in Health Care” podcast series.

The first in a series of reports, this study is a product of a larger effort by the state of Maryland and The Hilltop Institute to address questions related to the coordination of care for Medicaid recipients who are dually eligible for Medicare benefits. The report focuses on issues related to setting Medicaid payment rates. Although based on Maryland data alone, results from this study will be broadly relevant to other states as well.

This website is an on-line query system based on AoA-related data files and surveys, and includes population characteristics from the Census Bureau. The system allows users to produce descriptive information in graphical or tabular form, at the level of detail most suited for their needs. The four options through AGID provide different levels of focus and aggregation of the data from individual data elements within Data-at-a-Glance to full database access within Data Files.