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

Preparing for State Preparing for State Exchanges in FY2014 Exchanges in FY2014

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

Long-term Care Long-term Care CoverageCoverage

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 Medicare & Medicaid ReformsReforms

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

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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/