States Implementing Health Reform: 2011 Timeline Rachel Morgan RN, BSN Committee 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 Project Primary Care Project Rural Health Project Minority Health Project NCSL’S Standing Committee on Health through grants from The Robert Wood Johnson Foundation The Kellogg Foundation HRSA’s Bureau of Primary Health Care Office of Rural Health Policy HHS’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

Preparing for State Exchanges in FY2014

ACA Expectations of States To structure and operate state exchanges. To structure and operate state exchanges. To conduct program eligibility screening. To conduct program eligibility screening. To ensure interoperability of the exchange with public programs. To ensure interoperability of the exchange with public programs. The dissemination of exchange information to consumers The dissemination of exchange information to consumers

Models and Guidance NAIC −“American Health Benefit Exchange Model Act” NAIC −“American Health Benefit Exchange Model Act” Joint Guidance from CMS & OCIIO− “Exchange and Medicaid IT Systems, Version 1.0” Joint Guidance from CMS & OCIIO− “Exchange and Medicaid IT Systems, Version 1.0”

FY 2011 Considerations 1.Establish state exchange structure. 2.Establish governance mechanisms. 3.Designate the duties of the exchange. 4.Conform state law to Federal ERISA fiduciary duties. 5.Grant necessary rulemaking authority.

Funding Opportunities  State Planning Grants  OCIIO−“Early Innovators Grants”  CMS−Funding for Medicaid Eligibility Determinations

ACA Provisions Increase funding for Federal activities Increase funding for Federal activities Enhance Medicare and Medicaid program integrity Enhance Medicare and Medicaid program integrity Expand the Recovery Audit Contractor (RAC) Program Expand the Recovery Audit Contractor (RAC) Program Exclude Medicaid participation based on certain provider actions Exclude Medicaid participation based on certain provider actions

OIG Work Plan HHS & DOJ work plans for FY2011 include a review of State Medicaid agencies program integrity activities.

Insurance Reforms in FY2011 Medical Loss Ratio (MLR) Requirements Uniformity of Consumer Information

Long-term Care Coverage

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

Medicare & Medicaid Reforms

Medicaid Options State Financial Hardship Exemption Community First Choice Option Promoting Health Homes

Medicaid Program Changes 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. 1.Improved provider screening for Medicaid programs 2. 2.Nonpayment of HACs 3. 3.Medicaid Quality Measurement Program

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Additional Resources NCSL's Health Reform Webpage fault.aspx Federal Government’s Health Reform Webpage