states implementing health reform: 2011 timeline rachel morgan rn, bsn committee director, health...
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States Implementing Health Reform: 2011 Timeline
Rachel Morgan RN, BSNCommittee Director, Health
State Federal Relations National Conference of State Legislatures
This webinar series is sponsored by these NCSL projects:
Legislative Health Staff Network (LHSN) Men’s Health ProjectPrimary Care ProjectRural Health Project
Minority Health ProjectNCSL’S Standing Committee on Health
through grants fromThe Robert Wood Johnson Foundation
The Kellogg FoundationHRSA’s Bureau of Primary Health Care
Office of Rural Health PolicyHHS’s Office of Minority Health
States Implementing Health Reform: 2011 Timeline
Rachel B. Morgan RN, BSN, Health Committee Director,National Conference of State Legislatures
November 10, 2010
Key Issues in FY2011?Key Issues in FY2011?
American Health Benefit Exchanges
Fraud, Waste, and Abuse
Insurance Reform
Long-Term Care Coverage
Medicare & Medicaid Reforms
Quality of Care
ACA Expectations of ACA Expectations of StatesStates
To structure and operate state To structure and operate state exchanges.exchanges.
To conduct program eligibility To conduct program eligibility screening.screening.
To ensure interoperability of the To ensure interoperability of the exchange with public programs.exchange with public programs.
The dissemination of exchange The dissemination of exchange information to consumersinformation to consumers
Models and GuidanceModels and Guidance
• NAIC −NAIC −“American Health “American Health Benefit Exchange Model Act”Benefit Exchange Model Act”
• Joint Guidance from CMS & Joint Guidance from CMS & OCIIO− OCIIO− “Exchange and “Exchange and Medicaid IT Systems, Version Medicaid IT Systems, Version 1.0”1.0”
FY 2011 ConsiderationsFY 2011 Considerations
1.1. Establish state exchange Establish state exchange structurestructure..
2.2. Establish Establish governancegovernance mechanisms. mechanisms.
3.3. Designate the Designate the dutiesduties of the exchange. of the exchange.
4.4. Conform state law Conform state law to Federal ERISA to Federal ERISA fiduciary duties.fiduciary duties.
5.5. Grant necessary Grant necessary rulemaking rulemaking authorityauthority..
Funding OpportunitiesFunding Opportunities
State Planning GrantsState Planning Grants
OCIIO−OCIIO−“Early Innovators Grants”“Early Innovators Grants”
CMS−CMS−Funding for Medicaid Funding for Medicaid Eligibility DeterminationsEligibility Determinations
ACA ProvisionsACA Provisions
• Increase funding for Federal Increase funding for Federal activitiesactivities
• Enhance Medicare and Medicaid Enhance Medicare and Medicaid program integrityprogram integrity
• Expand the Recovery Audit Expand the Recovery Audit Contractor (RAC) ProgramContractor (RAC) Program
• Exclude Medicaid participation Exclude Medicaid participation based on certain provider actionsbased on certain provider actions
OIG Work PlanOIG Work PlanHHS & DOJ work plans for FY2011 include a HHS & DOJ work plans for FY2011 include a review of State Medicaid agencies program review of State Medicaid agencies program
integrity activities.integrity activities.
Insurance Reforms in Insurance Reforms in FY2011FY2011
• Medical Loss Ratio (MLR) Requirements
• Uniformity of Consumer Information
Community Living Assistance Services and
Supports• Public long-term care insurance
program
• Voluntary payroll deduction
• Individuals must opt-out to not participate
• Five year vesting period
Medicaid OptionsMedicaid Options
• State Financial Hardship Exemption
• Community First Choice Option
• Promoting Health Homes
Medicaid Program Medicaid Program ChangesChanges
• Provider Screening and Enrollment
• Payment for Prescription Drugs
• Nonpayment for Health Care Acquired (HACs) Conditions
Medicare Changes
• Medicare Coverage Gap Discount Program
• Expansion of Coverage for Certain Services
Quality Provisions
• National Strategy for Quality Improvement in Health Care
• Many underlying threads amongst the 2011 provisions:1. Improved provider screening for
Medicaid programs2. Nonpayment of HACs3. Medicaid Quality Measurement
Program
Any Questions?• Use the Q and A panel on your screen.• To find the archived webinar next
week, go to http://www.ncsl.org/?TabId=21519.
• Please fill out the survey at the end of this webinar.
Thank you!
Additional Resources
NCSL's Health Reform Webpagehttp://www.ncsl.org/IssuesResearch/Health/tabid/160/Default.aspx
Federal Government’s Health Reform Webpagehttp://www.healthcare.gov/