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Provides for a temporary increase in Medicaid payments for certain primary care services furnished in CYs 2013 and 2014 by a physician with a primary specialty designation of family medicine, general internal medicine, or pediatric medicine such that the new rates for those years would be at least 100% of the applicable rate paid for such services under Medicare. Requirement...
Sets a new mandatory Medicaid eligibility threshold, effective January 1, 2014, for non-elderly (under age 65), non-pregnant individuals whose income does not exceed 133% of the FPL. (This includes childless adults; certain parents; and children ages 6-19 for whom mandatory Medicaid coverage rises from 100% to 133% of the FPL). Provides that the newly-eligible group be covered under benchmark or...
Beginning January 1, 2014, stipulates that states must use modified adjusted gross income (MAGI) to determine Medicaid (and CHIP as revised by section 2101(d) of the Senate Manager's Amendment) eligibility for most enrollees, including pregnant women, children, parents and other caretaker relatives, and the new adult group. The MAGI-based income methodologies do not apply to eligibility determinations for certain exempted groups,...
Amends the existing CHIPRA-authorized premium assistance option delineated at section 1906A of the SSA for Medicaid-covered children with an additional option (as opposed to a requirement as was originally envisioned in the legislation per the changes delineated at section 10203(b)(2) of the Senate Manager's Amendment) to apply this provision more broadly to all Medicaid beneficiaries (not only children). The option,...
As revised by sections 10201(a)(1) and 10201(a)(3) of the Senate Manager's Amendment, beginning January 1, 2014, states must cover under their respective Medicaid programs individuals under age 26 who were in foster care under the responsibility of the state on the date of attaining 18 years of age (or older as the state may have elected) and were enrolled in...
As revised by sections 1204(b)(1)(B), 1204(b)(2)(A), and 1204(b)(2)(B) of the HCERA, effective July 1, 2011 through September 30, 2019, increases by $6.3 billion the amount of federal Medicaid funding available to Puerto Rico, the Virgin Islands, Guam, the Northern Mariana Islands, and American Samoa. Effective July 1, 2011, increases territories’ regular Medicaid FMAP from 50% to 55%.
Beginning January 1, 2011, provides for a special Medicaid FMAP adjustment for qualifying states which, at any time during the preceding seven years, declared a major disaster and met other specified conditions.
Rescinds any unobligated funds otherwise available for expenditure from the Medicare Improvement Fund for any of FYs 2014 through 2018.
As revised by section 10203(d) of the Senate Manager's Amendment, extends the current CHIP authorization through September 30, 2015. As revised by section 10203(c)(1) of the Senate Manager's Amendment, for the period beginning October 1, 2015 through September 30, 2019 (FYs 2016-2019), provides for an increased FMAP to states under CHIP (increased by 23% relative to the state’s applicable FMAP...
Delineates a number of technical corrections to underlying CHIPRA and ARRA-authorized provisions that became effective as if included in the enactment of these pieces of legislation.
Beginning January 1, 2014, states must provide for a streamlined enrollment system for Medicaid, CHIP, and Exchanges via an Internet website whereby individuals may enroll or re-enroll in such applicable plan. Stipulates that states must make certain that individuals who apply for but are determined ineligible for Medicaid or CHIP (or a waiver program thereof) are screened for eligibility in...
Permits hospitals to make presumptive eligibility determinations for all Medicaid-eligible populations beginning January 1, 2014,
Effective upon enactment of the ACA (i.e., March 23, 2010), unless state legislation is required (for which certain exceptions are made), requires states to cover freestanding birth center services and other ambulatory services that are offered by a freestanding birth center. In addition, provides for separate payments to certain providers who provide prenatal labor and delivery or postpartum care services...
Effective upon the ACA’s enactment (i.e., March 23, 2010), authorizes payment to be made under Medicaid and CHIP for hospice services provided to children with a terminal illness while still enabling such children to receive access to curative treatment for such terminal illness.
Beginning March 23, 2010, provides for a new optional group under Medicaid for individuals who are not pregnant and whose income does not exceed the highest income eligibility level under the state plan for pregnant women. States may also include individuals who were previously made eligible for family planning services under a section 1115 waiver. Authorizes a state option for...
Effective presumably upon enactment of the ACA (i.e., March 23, 2010), provides that “medical assistance” includes “the care and services themselves” as well as the payment for the provision of care.
As revised by section 1205 of the HCERA, beginning October 1, 2011, designates a new Medicaid SPA option under which states may offer home and community-based attendant services and supports to individuals whose income does not exceed 150% of the FPL or, if greater, the income level applicable to an individual who would otherwise require an institutional level of care....
Requires the Secretary of HHS to issue regulations directing states to design service systems that account for specified factors, including that systems maximize beneficiaries' independence, improve coordination among providers and so forth. Effective on the first day of the first FY quarter that begins upon enactment of the ACA (i.e., presumably April 1, 2010 – though refer to implementation status...
Beginning April 23, 2010, authorizes the extension of the current Money Follows the Person (MFP) demonstration through FY 2016. Relative to an individual’s qualification under the demonstration, decreases the institutional residency period requirements (to minimum of 90 consecutive days).
Effective January 1, 2014 through December 31, 2019, requires states to extend spousal impoverishment protections to individuals receiving Medicaid HCBS (including individuals receiving such services under a waiver).
Appropriates to HHS via the AoA (now ACL) $10 million for each of FYs 2010-2014 to expand state aging and disability resource centers (ADRCs).
Delineates the findings of the Senate relative to the status of long-term care in the country, calling upon the 111th Congress to address long-term services and supports in a comprehensive manner and that these services also be made available in the community.
As revised by section 1206 of the HCERA, beginning January 1, 2010, provides for an increase in the Medicaid minimum rebate percentage for single source drugs and innovator multiple source drugs from 15.1% to 23.1%. However, for drugs for clotting factors and those drugs approved by the FDA exclusively for pediatric indicators, the rebate increases to 17.1%. Includes a provision...
Beginning January 1, 2014, prohibits the exclusion of certain drugs for coverage under Medicaid, specifically certain smoking cessation agents, barbiturates, and benzodiazepines.
As revised by section 1101(c)(3) of the HCERA, effective on the first day of the first CY quarter that begins at least 180 days upon enactment of the ACA (i.e., October 1, 2010), directs HHS to set the federal upper limit (FUL) amount at, at minimum, 175% of the weighted average of the most recently reported monthly Average Manufacturer Price (AMP) prices...
As revised by section 1203(b) of the HCERA and section 10201(e)(1) of the Senate Manager's Amendment, directs HHS to, for each of FYs 2014-2020, reduce federal Medicaid DSH allotments to states with the lowest percentage of uninsured or states that do not target their DSH payments to hospitals with a high volume of Medicaid inpatients and high uncompensated care. Notes that aggregate...
Effective March 23, 2010, authorizes section 1115 Medicaid waivers (as well as waivers under sections 1915(b) and 1915(c)) through which a state serves individuals who are dually eligible for Medicaid and Medicare to be carried out over a 5-year initial period. Upon Secretarial approval, waivers may be extended for additional 5-year periods. (Note that under pre-ACA law, section 1915(c) waivers...
By March 1, 2010, directs HHS to establish a CMS Federally Coordinated Health Care Office ("Medicare-Medicaid Coordination Office" or “Duals Office”). Specifies that the office's purpose is to, among other functions, integrate and coordinate Medicare and Medicaid benefits for dual-eligibles. Directs HHS to report to Congress (via the Department’s annual budget submission process) on the office's efforts, including legislative recommendations.
Amends CHIPRA to require HHS to develop a core set of health care quality measures for Medicaid-eligible adults in the same manner that it currently does for children. Measures are to be published for public comment by January 1, 2011, followed by the subsequent publication of an initial core set by January 1, 2012. Requires the development of a standardized format...
Directs HHS to identify current state-level practices that prohibit payment for health care-acquired conditions (HACs) and to incorporate any applicable practices into a forthcoming mandated Medicaid regulation that is due to take effect by July 1, 2011. Specifically, the regulation is to prohibit Medicaid payment to states for amounts expended on care stemming from HACs. Also requires HHS to take into consideration the HACs...
Beginning January 1, 2011, creates a Medicaid state plan amendment (SPA) option for states to cover eligible individuals with chronic conditions who select a designated provider, a team of health care professionals operating with such a provider, or a health team as the individual’s health home for purposes of providing the individual with health home services. Eligible individuals include those...
Effective January 1, 2012 through December 31, 2016, directs the Secretary of HHS to establish an 8-state Medicaid demonstration project to evaluate the use of bundled payments to hospitals and physicians for the provision of integrated care. Among other things, requires that the demonstration focus on conditions for which there is evidence of an opportunity for providers to improve the...
Directs HHS, with the Center for Medicare and Medicaid Innovation (CMMI), to conduct a 5-state demonstration project during FYs 2010-2012 such that Medicaid payments to an eligible safety net hospital system or network would be made using a global capitated payment model (as opposed to FFS). Removes any otherwise applicable budget neutrality requirements. Directs HHS to, by 12 months after the demonstration's conclusion (i.e.,...
Directs the Secretary of HHS to establish a demonstration project – that operates from January 1, 2012 through December 31, 2016 – in which participating pediatric medical providers would be rewarded as recognized Medicaid ACOs for meeting specified requirements. Among other requirements, directs participating states to, in consultation with HHS, establish an annual minimum savings level for items and services...
Directs the Secretary of HHS to establish a 3-year demonstration project in which participating states provide Medicaid payments to qualifying non-publicly owned or operated institutions for mental diseases (IMDs) for services provided to Medicaid-eligible beneficiaries ages 21-64 who require such services in order to stabilize an emergency medical condition (and for whom Medicaid coverage would otherwise not be available -...
Revises the Medicaid and CHIP Payment and Access Commission’s (MACPAC) annual reporting requirements relative to its March and June reports to Congress (from March 1 to March 15; and from June 1 to June 15), as well as expounds upon the topics to be reviewed by the Commission (e.g., enrollment and retention policies, quality of care, and so forth). Furthermore...
Specifies that there may be no cost-sharing applied to Indians whose income is at or below 300% of the FPL and is enrolled in a QHP in the individual market in the Exchange. Clarifies that health care programs operated by the IHS, Indian tribes, tribal organizations, and urban Indian organizations are the payer of last resort. Adds Indian tribes and...
Beginning January 1, 2010, strikes the 5-year sunset provision in the statute, permitting ongoing reimbursement for all Medicare Part B services furnished by certain Indian hospitals and clinics.
Directs states to, not later than six months upon enactment of this section and as a condition of receipt of maternal and child health allotments, conduct (and report to the Secretary of HHS accordingly) a statewide needs assessment to identify at-risk communities as defined in statute. Directs HHS to award grants available for early childhood home visitation programs. Such grants...
Authorizes the Secretary of HHS to expand and intensify activities pertaining to postpartum depression or postpartum psychosis, including research to expand the understanding of the causes of, and treatments for, postpartum conditions. Expresses the sense of the Congress requesting the NIH to conduct a nationally representative longitudinal study over the FY 2010-2019 period of relative mental health consequences for women...
As revised by section 10201(h) of the Senate Manager's Amendment, for FYs 2010-2014, directs the Secretary of HHS to make allotments available to states (based on a specified formula) to implement personal responsibility education programs. Such programs are required to educate adolescents on both abstinence and contraception for the prevention of pregnancy and STDs consistent with certain requirements, as well...
Restores funding for abstinence education via the extension of the $50 million appropriation for each of FYs 2010-2014.
Beginning October 1, 2010, specifies certain requirements relative to transition planning for children aging out of foster care about the importance of designating another individual to make health care treatment decisions on behalf of the child in certain circumstances. Makes amendments towards this end addressing independent living programs, as well as health oversight and coordination plans.
(Note that the majority of the amendments authorized under section 10201 of the Senate Manager's Amendment are incorporated within the underlying section summaries; however, with respect to section 1115 waivers, a new subsection (i) was added and hence necessitates a separate summary). Requires the Secretary of HHS to promulgate regulations by September 23, 2010 that pertain to the applications for,...
Creates a new State Balancing Incentive Payments program for qualifying states to offer Medicaid HCBS as a long-term care alternative to nursing homes. Participating states are eligible for up to a 5% increase in their applicable FMAP (or 2% in certain cases) over the FY 2012 through FY 2015 period. Delineates target spending percentages for the state to achieve by...
Defines key terms, such as “accompaniment” and “eligible institution of higher education,” relative to the newly-established Pregnancy Assistance Fund at section 10212.
Directs the Secretary of HHS, in collaboration and coordination with the Secretary of ED (as appropriate) to establish a Pregnancy Assistance Fund (PAF) for the purpose of awarding competitive grants to states to assist pregnant women.
Sets forth the permissible use of the Pregnancy Assistance Fund, particularly as it pertains for use by institutions of higher education (with specified matching requirements). Includes provisions focused on improving services for pregnant women who are victims of domestic violence, sexual violence, sexual assault and stalking.
Appropriates $25 million for each of FYs 2010-2019 to carry out the initiatives of the Pregnancy Assistance Fund (as specified in sections 10211, 10212, and 10213 of the Senate Manager's Amendment).
Incorporates and enacts the Indian Health Care Improvement Act (IHCIA) (S.1790), with some amendments, as reported by the Committee on Indian Affairs in December 2009.
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