ACA Now

Implementation Status

2011

Prior to January 2013, a September 23, 2011 CMS transmittal, addressed the incorporation of this provision (and others) into the Medicaid Program Integrity Manual.  HHS also addressed the manner in which it has begun to implement such provision in a September 2011 report to Congress.

2013

On Aug. 23, CMS issued guidance to states outlining anticipated changes, including those related to program integrity consistent with this provision of the ACA, to the Medicaid Statistical Information System (MSIS) – to be known as Transformed-MSIS (T-MSIS).  The document elaborates on key capabilities, available technical assistance, and next steps for implementing T-MSIS on a “rolling basis” with states.

2015

On May 1 CMS released an interim final rule to amend a May 2014 rule requiring Part D sponsors to deny a pharmacy claim for a Part D drug if the physician who wrote the prescription does not meet Medicare program eligibility requirements.

On May 26, CMS released an extensive proposed rule (press release; fact sheet) on Medicaid and CHIP managed care that seeks to acknowledge increased enrollment in managed care delivery systems and promote cross-market alignment with Marketplace QHPs and Medicare Advantage (MA).

On June 29, GAO released a report on services utilization among Medicaid managed care beneficiaries, using encounter data from 19 reported under this provision.

2016

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.

On May 9, CMS announced the release of the 2014 Medicaid Managed Care Enrollment Report (PDF). The annual report profiles enrollment statistics for Medicaid managed care programs as of July 1 of each year.

2019

On Sept. 5,  CMS issued a final rule with comment period that creates new revocation and denial authorities regarding Medicaid and CHIP provider enrollment that the agency says will assist in eliminating waste, fraud, and abuse and will allow CMS the ability to identify and remove providers and suppliers who pose a risk of such activity. Details.