A Strong Foundation for System Transformation
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1 A Strong Foundation for System Transformation Disabled and Elderly Health Programs Group Center for Medicaid, CHIP and Survey & Certification Centers for Medicare & Medicaid Services April 7, 2011
2 Top 5% in Medicaid Expenditures Age Duals vs Non-Duals 16% 14% Under 21 24% 47% Over 85 46% 54% Duals Non-Duals Source: CMS Analysis of MSIS data FY2008
3 The Current Landscape: Medicaid LTC LTC = 32% of total Medicaid spending, $115 b 2009 Institutional LTC (NFs) still the entitlement, though the Americans with Disabilities Act (ADA) makes it a civil right for individuals with disabilities to receive public services in most integrated community setting Source: Thomson Reuters, Medicaid Long-Term Expenditures in FY 2009
4 Provisions of The Affordable Care Act Supports most integrated setting appropriate Offers new option for integrating and linking services for complex, high cost populations Offers new or improved HCBS State Plan options Offers enhanced FMAP to help states modify delivery systems
5 Provisions of The Affordable Care Act: Section 2703: Health Homes for Individuals with Chronic Conditions Option for individuals with multiple chronic conditions or Serious Mental Illness effective January 1, 2011 Coordinated, person-centered care Primary, acute, behavioral, long term care, social services = whole person Enhanced FMAP (90%) is available for the health home services (first 8 quarters)
6 The Affordable Care Act (ACA) opens MFP to more States Extends and expands MFP through 2016 Offers States substantial resources and additional program flexibilities to remove barriers Enhanced FMAP for community services for first year following transition from facility 43 States and the District of Columbia now participating in the demonstration
7 Provisions of The Affordable Care Act: Section 2402: Removing Barriers to HCBS Section 1915(i) established by DRA of 2005 State option to amend the state plan to offer HCBS as a state plan benefit; does not require institutional LOC Modified under ACA effective October 1, 2010 to allow comparability waivers, add other services States cannot waive statewideness or cap enrollment 7
8 Provisions of The Affordable Care Act: Section 2401: Community First Choice Option Adds Section 1915(k) Optional State Plan benefit to offer Attendant Care and related supports in community settings, providing opportunities for selfdirection Does not require institutional LOC under 150% FPL Includes 6% enhanced FMAP
9 Provisions of The Affordable Care Act: Section 10202: Balancing Incentive Program Effective October 1, 2011 Enhanced FMAP to increase diversions and access to HCBS 2% if less than 50% LTSS spending in non-institutional settings 5% if less than 25% LTSS spending in non-institutional settings CMS Guidance and Application targeted for mid-2011
10 Dual Eligibles Federal Office of Coordinated Health Care Demonstrations - $1 million to up to 15 states to design integrated models (including shared savings) Supported by Center for Innovations Health homes and MCOs/SNPs models for dual integration
11 CMCS Assistance to States Continuing serious budget concerns for States Secretary Sebelius letter to Governors - committed to help States implement effective cost control Modify benefits Manage care for high cost enrollees Purchase drugs more effectively Assure program integrity
12 LTSS System Transformation A key element of effective cost management Key to State compliance with obligations under Olmstead/ADA CMCS will offer TA to leverage ACA and other available tools of transformation Sec waiver template to put HCBS first Guidance on managed care for persons living with chronic and disabling conditions
13 SMDs and Regulations Medicaid Prescription Drug Rebates SMD 10006,SMD Community Living Initiative (Olmstead Tool Kit) SMD Money Follows The Person Extension SMD (i) SMD Concurrent Hospice Care for Children SMD yr Approval or Renewal Period for Certain Medicaid Waivers SMD Health Homes for Enrollees with Chronic Conditions SMD Code of Regulations Rx AMP Withdrawal Reg CMS-2238-P2
14 Additional Information CMS: Community Services and Long-Term Supports State Medicaid Director Letters MFP Technical Assistance Website
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