Improving health is our policy
Beginning January 1, 2013, provides for a 1% FMAP increase for certain adult vaccines and clinical preventive services to states that cover, without cost-sharing, specified preventive services (assigned a grade of A or B by the USPSTF) and adult vaccines (recommended by the Advisory Committee on Immunization Practices (ACIP)).
2013
On February 1, 2013, issued a SMD letter to inform states of this new option.
In a related note, in early 2013, AHRQ released its Guide to Clinical Preventive Services, which serves as a pocket guide for practitioners and others, and includes USPSTF recommendations on screening, counseling, and preventive medication topics and includes clinical considerations for each topic. For details, see here. See also related FAQ, issued on February 20 by CCIIO, on coverage of preventive health services as it pertains to Title I provisions.
In a related note and as referenced above (under section 2713 PHSA), on March 18, 2013, HHS released a report in which it pointed to new data that showed that roughly 71 million Americans in private health insurance plans received coverage for at least one free preventive health care service, in 2011 and 2012 due to the new requirements under the ACA.
On July 11, 2013, HHS issued a tri-agency (CMS, SAMHSA, and ACF) letter to states in which it outlined a number of resources and existing authorities available to states to provide integrated approaches to effectively screening and caring for children and youth who have experienced complex trauma, highlighting for example, opportunities for enhanced federal financial participation (FFP) under this provision of the ACA for certain preventive services.
On Nov. 27, 2013, CMS issued an informational bulletin delineating opportunities to enhance access to Medicaid preventive services, including clarification around scope of provider issues, HIV screening, and so forth. Additional details are also available here.
On November 27, 2013, CMS issued an informational bulletin detailing various initiatives/opportunities to enhance access to Medicaid preventive services. Among other things, the guidance reiterates changes around Medicaid scope of provider regulations that were recently codified in a final rule; updates on HIV screening; and information pertaining to a new Medicaid Prevention Learning Network. The guidance clarifies the services eligible for the enhanced Medicaid FMAP pursuant to this section of the law.
2014
On June 20, 2014, CMS issued an information collection in which it requests OMB approval and public comments (deadline: on or around July 20) on a newly proposed survey of states’ efforts to enhance utilization of preventive services in Medicaid and CHIP. The agency says the “results will provide a baseline regarding the coverage of preventive services and will help us identify ways to assist states with materials focusing on prevention and technical assistance.” Note also that, earlier that month, CMS launched a national outreach initiative, “From Coverage to Care” (C2C), to assist consumers in using health coverage they’ve newly obtained through Marketplaces. CMS indicated that the initiative focuses on consumer awareness of preventive and primary care services, as well as giving providers “the tools they need to promote patient engagement.”
On a related note, HHS announced the extension of the comment period – to Mar. 23 – on its draft National Adult Immunization Plan (NAIP).
On Apr. 25, CMS released an extensive final rule on Medicaid and CHIP managed care (press release; add’l fact sheets available here under “final rule”) that seeks to acknowledge increased enrollment in managed care delivery systems and – to facilitate beneficiaries’ transitions and care management across product lines – promote cross-market alignment with Marketplace Qualified Health Plans (QHPs) and Medicare Advantage (MA). The final rule addresses these provisions of the ACA.
SEC. 4106. IMPROVING ACCESS TO PREVENTIVE SERVICES FOR ELIGIBLE ADULTS IN MEDICAID. (a) CLARIFICATION OF INCLUSION OF SERVICES.
—Section 1905(a)(13) of the Social Security Act (42 U.S.C. 1396d(a)(13)) is amended to read as follows: ‘‘(13) other diagnostic, screening, preventive, and rehabilitative services, including— ‘‘(A) any clinical preventive services that are assigned a grade of A or B by the United States Preventive Services Task Force; ‘‘(B) with respect to an adult individual, approved vaccines recommended by the Advisory Committee on Immunization Practices (an advisory committee established by the Secretary, acting through the Director of the Centers for Disease Control and Prevention) and their administration; and ‘‘(C) any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level;’’. (b) INCREASED FMAP.—Section 1905(b) of the Social Security Act (42 U.S.C. 1396d(b)), as amended by sections 2001(a)(3)(A) and 2004(c)(1), is amended in the first sentence— (1) by striking ‘‘, and (4)’’ and inserting ‘‘, (4)’’; and (2) by inserting before the period the following: ‘‘, and (5) in the case of a State that provides medical assistance for services and vaccines described in subparagraphs (A) and (B) of subsection (a)(13), and prohibits cost-sharing for such services and vaccines, the Federal medical assistance percentage, as determined under this subsection and subsection (y) (without regard to paragraph (1)(C) of such subsection), shall be increased by 1 percentage point with respect to medical assistance for such services and vaccines and for items and services described in subsection (a)(4)(D)’’. (c) EFFECTIVE DATE.—The amendments made under this section shall take effect on January 1, 2013.
(202) 309-0796
Contact Us