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7/31/2013

Developing Provider Networks for Medicaid Managed Long-Term Services and Supports Programs: Considerations for States

States establishing MLTSS programs need to ensure that health plans' provider networks address the diverse needs of Medicaid's most vulnerable populations. This brief presents considerations for provider network development, reviews recent guidance, and offers examples of state practices for establishing MLTSS network adequacy standards.

pdf File Developing Network Adequacy for MLTSS FINAL 2 .pdf [download]
 
 

7/31/2013

Development of the Financial Alignment Demonstrations for Dual Eligible Beneficiaries: Perspectives from National and State Disability Stakeholders

Website  from http://kff.org

As part of the implementation of the Affordable Care Act, 26 states submitted proposals to the Centers for Medicare and Medicaid Services (CMS) to implement demonstrations to integrate care and align financing for beneficiaries who are dually eligible for Medicare and Medicaid; as of July 2013, six states have received approval from CMS to implement a demonstration, and 16 proposals remain pending review. Given the degree of interest in these demonstrations, we sought to identify common issues and potential solutions to inform other states as they develop and implement demonstrations. With an emphasis on illuminating the specific concerns of beneficiaries under age 65 and those who use long-term services and supports, we conducted a series of 26 structured interviews with national and state disability stakeholders from October 2012 through January 2013.

pdf File 8461-development-of-the-financial-alignment.pdf [download]
 
 

7/31/2013

Three State Paths to Improve Medicaid Managed Long-Term Care: Florida, New Jersey, and Virginia

Emerging MLTSS programs are shaped not only by a state's internal resources, but also by the state's experiences in interacting with long-term service and support providers, managed care plans, and beneficiaries. This brief looks at the MLTSS program design and implementation decisions made by three states to inform other states' planning. It also identifies how states' efforts in MLTSS pave the way for future coordination of Medicare and Medicaid benefits.

pdf File Three Paths to Medicaid MLTSS FINAL 2 .pdf [download]
 
 

7/24/2013

New Health Affairs Policy Brief: Health Insurance Exchanges and State Decisions

On October 1, 2013, if all goes as planned, state health exchanges will fire up their respective web portals and kick off open-enrollment season--as part of the implementation of the Affordable Care Act (ACA). Individuals and small businesses will be able to purchase health insurance coverage that will take effect on January 1, 2014. A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation provides a primer on the exchanges and what lies ahead. It expands and updates points made in several previously released Health Policy Briefs.

 
 

7/24/2013

AARP PPI, NASUAD and HMA Releases a New Report on Long-Term Services and Supports

On July 16th, 2013, AARP Public Policy Institute, National Association of States United for Aging and Disabilities (NASUAD) and Health Management Associates (HMA) released At the Crossroads: Providing Long-Term Services and Supports at a Time of High Demand and Fiscal Constraint, a new report highlighting the challenges facing states in providing long-term services and supports (LTSS). Even as states begin to implement LTSS options in the Affordable Care Act that increase access to Medicaid home and community based services (HCBS), most states did not increase funding for non-Medicaid services including senior centers, information and referral, transportation and caregiver supports, such as those under the Older Americans Act. The report examines findings of the third annual survey of LTSS systems across 49 states and the District of Columbia, highlighting transformations and reforms underway, and trends across the country. The report found that more states are increasing participation in HCBS options within the Affordable Care Act as well as initiatives for individuals who are dually eligible for Medicaid and Medicare. At the same time, states are seeing increased demand for non-Medicaid services; for example, the caseload for adult protective services for victims of abuse or exploitation has increased in the last two years without increased funding in many states.

 
 

7/24/2013

GAO Testimony on the Status of CMS Efforts to Establish Exchanges

John E. Dicken of the Government Accountability office delivered this testimony on the status of CMS efforts to establish federally facilitated health insurance exchanges and the federal data services hub.

pdf File 655905.pdf [download]
 
 

7/24/2013

New Kaiser Analyses Examine the Impact of State Decisions Not to Expand Medicaid Under the ACA

Two new analyses released today by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) examine how decisions by states not to expand Medicaid under the Affordable Care Act (ACA) will blunt the law's effectiveness in reducing the uninsured population. As of today, 24 states are moving forward with the Medicaid expansion, 21 states are not and 6 states are still debating the matter.

 
 

7/24/2013

The Impact of Current State Medicaid Expansion Decisions on Coverage by Race and Ethnicity

Website  from http://kff.org

One of the major vehicles in the Affordable Care Act (ACA) to increase health insurance coverage is an expansion of Medicaid to adults with incomes at or below 138% of the federal poverty level (FPL). While the expansion was intended to be implemented in all states, as a result of the Supreme Court decision on the ACA, it is now effectively a state choice. Based on an analysis of 2011 American Community Survey data, this brief examines the implications of current state Medicaid expansion decisions on coverage by race and ethnicity.

 
 

7/18/2013

Agency Information Collection Activities: Submission for OMB Review; Comment Request

The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS' intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice.

 
 

7/18/2013

CMS final rule on Standards for Navigators and Non-Navigator Assistance Personnel; Consumer Assistance Programs, and Certified Application Counselors

This final rule addresses various requirements applicable to Navigators and non-Navigator assistance personnel in Federally-facilitated Exchanges, including State Partnership Exchanges, and to non-Navigator assistance personnel in State Exchanges that are funded through federal Exchange Establishment grants. It finalizes the requirement that Exchanges must have a certified application counselor program. It creates conflict-of-interest, training and certification, and meaningful access standards; clarifies that any licensing, certification, or other standards prescribed by a state or Exchange must not prevent application of the provisions of title I of the Affordable Care Act; adds entities with relationships to issuers of stop loss insurance to the list of entities that are ineligible to become Navigators; and clarifies that the same ineligibility criteria that apply to Navigators apply to certain non-Navigator assistance personnel.

 
 

7/18/2013

New Animation Explains Changes Coming for Americans Under Obamacare

Website  from http://kff.org

With major parts of the Affordable Care Act (ACA) going into effect in 2014, the Kaiser Family Foundation released a new animated video to help people understand the health care system changes on the horizon. "The YouToons Get Ready for Obamacare" explains the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, whether it's through their employer, Medicaid, Medicare, or buying insurance on their own with the help of federal tax credits.

 
 

7/16/2013

CMS Releases Final Rule on Essential Health Benefits in Medicaid Alternative Benefit Plans, Eligibility Notices, Hearings, and Cost-Sharing

On July 5, 2013, CMS issued a final rule implementing provisions of the Affordable Care Act related to eligibility, enrollment, and benefits in Medicaid, the Children's Health Insurance Program (CHIP) and the Health Insurance Marketplace. This final rule addresses aspects of the Medicaid, CHIP and Marketplace eligibility notices and appeals processes; provides additional flexibility regarding benefits and cost sharing for state Medicaid programs; codifies several eligibility and enrollment provisions included in the Affordable Care Act and the Children's Health Insurance Program Reauthorization Act (CHIPRA) and provides operational guidance to help states implement their Health Insurance Marketplaces.

 
 

7/16/2013

KFF's New Issue Brief Compares Six Approved States' Financial Alignment Demonstrations for Dual Eligible Beneficiaries

Website  from http://kff.org

KFF recently released an issue brief, Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS. This issue brief compares demonstration programs in California, Illinois, Massachusetts, Ohio, Virginia, and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.

 
 

7/16/2013

Obama Administration Awards $150 Million to Assist Enrollment into Affordable Health Coverage

On July 10, 2013, Health and Human Services (HHS) Secretary Kathleen Sebelius announced $150 million in grant awards to 1,159 health centers across the nation to enroll uninsured Americans in new health coverage options made available by the Affordable Care Act. With these funds, health centers in all 50 states are expected to hire an additional 2,900 outreach and eligibility assistance workers to assist millions of people nationwide with enrollment into affordable health coverage.

 
 

7/16/2013

Prescribed: A Personalized Tour of Obamacare

Still have questions about how the Affordable Care Act affects YOU? The Wall Street Journal offers this interactive video to answer the most common questions.

 
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