State Medicaid Director's letters

The Centers for Medicare & Medicaid Services, along with Mission Analytics Group & Human Services Research Institute, created an implementation manual for the Balancing Incentive Program. The Program encourages states to increase the percentage of long-term care dollars going to home & community-based services through making additional Federal Medical Assistance Percentages available to States that are currently lower performing. This manual aims to help States make the most of this Program.

Medicaid officials in every state are enacting a variety of cost cutting measures as states’ spending is projected to increase 28.7% in FY2012 to make up for the loss of federal stimulus money. The survey finds cost containment actions ranging from restrictions on payments to providers & benefits, to new copayments for beneficiaries & additional efforts to contain the costs of prescription drugs. States are also trying to make their programs more efficient through a number of procedures.

This letter provides guidance to States on the implementation of Section 10202 of the Affordable Care Act, which establishes the “State Balancing Incentive Payments Program” hereafter referred to as the Balancing Incentive Program. This letter provides a high-level overview along with the required structural changes and timeframes for implementation. Also review the attached Section 10202 Initial Announcement.

This letter provides guidance on state flexibility to make changes to their home and community-based services (HCBS) programs while complying with the maintenance of effort (MOE) provision of the Affordable Care Act. Letter recommends that States contact CMS for technical assistance if they are interested in pursuing any changes to their long-term care policies. The accompanying Q&As provide guidance on the MOE provisions in the Patient Protection and Affordable Care Act.

This letter provides initial guidance on section 6411 of the Affordable Care Act, Expansion of the Recovery Audit Contractor (RAC) Program, which amends section 1902(a)(42) of the SSA requiring States to establish programs to contract with RACs to audit payments to Medicaid providers by December 31, 2010. CMS expects States to fully implement their RAC programs by April 1, 2011. As required by statute, CMS will be issuing regulations in this area shortly, providing additional guidance.

This letter informs States of several changes to Section 1915(i) of the Social Security Act (the Act) made by the Affordable Care Act (ACA). These changes, which become effective October 1, 2010, include revised and new 1915(i) provisions for removal of barriers to offering HCBS services through the Medicaid State plan. This letter is intended to provide guidance on important changes to the law including: Number Served & Statewideness, Financial Eligibility, Targeted Benefits and Services.

This letter provides guidance to State Medicaid agencies regarding implementation of section 4201 of the American Recovery and Reinvestment Act of 2009 (the Recovery Act), Pub. L. 111-5, and our recently published regulations at 42 CFR Part 495, Subpart D. Section 4201, as well as our final regulations, will allow the payment of incentives to eligible professionals (EPs) and eligible hospitals to promote the adoption and meaningful use of certified electronic health record (EHR) technology.

The Affordable Care Act (ACA) includes the extension of the MFP Demonstration Program for an additional 5 years. This letter provides background about the MFP Demonstration Program, explains improvements made by the ACA, details how the ACA will impact current MFP grantees, and provides preliminary information for non-participating States that may be interested in pursuing new funding.

Changes CMS is making in the State plan amendment (SPA) review process are explained in this letter. CMS has identified a process that will expedite the review of SPAs while ensuring that CMS and States resolve other questions that may arise. States will now have the option to resolve issues related to State plan provisions that are not integral to the SPA through a separate process. Several examples based on actual State plan issues are included.

This letter was issued to provide information on new tools for community integration and to remind States of existing tools that remain strong resources in their efforts to support community living. Various technical assistance resources are listed, including a new guide for enhancing the availability of HCBS within managed care delivery systems. Progress around the HUD partnership, HCBS waiver and state plan options, grant programs, ADRCs and discharge planning are discussed as well.