NAMD Memo on Eligibility Regs; MITA 3.0 Guidance; Hill News

Post date: 
April 2, 2012

From the NAMD Desk
Regulatory News
Hill Update
In the News
Other Items of Interest
Mark Your Calendar

From the NAMD Desk [back to top]

NAMD submits comment letter on domestic service workers. On March 21, NAMD submitted a letter in response to the Department of Labor's proposed regulation, "Application of the Fair Labor Standards Act to Domestic Service." In its letter, NAMD indicates it shares the DOL's belief that the availability of appropriately trained workers is essential to providing adequate care to seniors and people with disabilities. However, NAMD identifies several concerns the proposed changes could have for some state Medicaid programs. Specifically, in some states the rule could disrupt Medicaid home and community based services programs, create extensive new administrative burdens and complexities, add significantly to the cost of providing Medicaid long term services and supports. The letter is posted at:

NAMD memo: Medicaid eligibility regulation. NAMD released analysis of the final rule, "Medicaid Program; Eligibility Changes under the Affordable Care Act of 2010" [CMS-2349-F]. This memo identifies some of the key changes from the proposed rule, outstanding issues and a detailed summary of CMCS' responses to NAMD's comments on the proposed regulation. The analysis is posted on NAMD's website:

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Regulatory News

MITA 3.0 Guidance Finalized. CMS released MITA 3.0 last Thursday, following a four-month comment period. MITA is the technology framework and standards for Medicaid. The 3.0 version incorporates a number of recent legislative changes, including the CHIP Reauthorization Act (CHIPRA), the ACA, and the Health Information Technology for Economic and Clinical Health Act (HITECH) under the Recovery Act of 2009. In addition, the recent revisions are intended to accommodate newer technologies, such as cloud computing, as well as IT-related guidance from CMS. However, it should be noted that the recent Medicaid and Exchange eligibility rules are not reflected in 3.0, due to the timing of their release --Those updates are forthcoming. The MITA 3.0 Framework can be downloaded at If you have questions, you can contact Donna Schmidt at

CMS seeks comments on revisions to MC External Quality Review protocols. New legislative requirements in CHIPRA, HITECH, and the Affordable Care Act necessitate updates to the CMS External Quality Review (EQR) protocols originally published in 2003. The announcement concerning these revisions was published in the Federal Register on February 17, 2012 at The draft revised EQR Protocols are available for viewing and download at the CMS website: - and click on the link CMS-R-305 to access the full set of draft revised protocols. Public comments are due April 17, 2012.

Information on the current CMS External Quality Review Protocols is available at:

New federal requirement for housing-Medicaid partnership. In January 2011, the Frank Melville Supportive Housing Investment Act of 2010 was signed into law. This legislation reforms the U.S. Department of Housing and Urban Development (HUD) Section 811 Supportive Housing for Persons with Disabilities Program. The new Section 811 approach requires a partnership be established between the housing agency applying for the Project Based Rental Assistance and the state Medicaid agency. Language in the Melville Act stipulates that:

"Assistance under this paragraph may be provided only for projects for which the applicable State agency responsible for health and human services administer or supervise the administration of the State Plan for medical assistance under title XIX of the Social Security Act, have entered into such agreements as the Secretary considers appropriate-
(i) to identify the target populations to be served by the project
(ii) to set forth methods for outreach and referral
(iii) to make available appropriate services for tenants of the project"

HUD has announced its plan for the release of the FY 2012 Section 811 Notice of Funding Availability (NOFA) in the spring of 2012. This NOFA will focus on the new Section 811 Project Rental Assistance (PRA) authority, which will provide Section 811 PRA funding directly to state housing agencies. CMCS is planning a webinar soon after the HUD NOFA announcement to help Money Follows the Person (MFP) grantees, other human service programs, and state housing officials understand the 811 NOFA requirements.

Additional technical assistance is available through CMC's contractor, TAC, at:

RECAP: CMS all-state call on Medicaid portal and 2014 TA Teams. On March 20th, CMS conducted a call with states to describe their plan for several new technical assistance efforts that will be launched in the coming weeks and months, including the new State Operations and Technical Assistance (SOTA) teams. The SOTA teams, made up of a multidisciplinary state team plus a team leader, will serve as coordinated points of contact to assist states with 2014 implementation. CMCS plans to begin reaching out to Medicaid Directors in the coming weeks. CMCS plans to make a transcript of all future TA webinars on the eligibility regulation, available on its website,

Latest update on Strong Start Initiative. The CMS Innovations Center and CMCS continue efforts to promote this initiative with an applicant conference call on budgeting. During that call, they also announced that the LOI deadline (orig. 3/21) has been pushed to mid-May. The application deadline in June has not shifted. As a reminder, the initiative is designed to support reductions in pre-term labor and poor birth outcomes for Medicaid beneficiaries. (For more detail, go to

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Hill Update

TX Medicaid Director testifies before Senate Finance Subcommittee. Texas Medicaid Director Billy Millwee testified at a hearing convened by the Senate Finance Committee's Subcommittee on Health. During the March 22nd hearing, "Prescription Drug Abuse: How are Medicare and Medicaid Adapting to the Challenge?" Millwee joined a panel of doctors and healthcare experts to discuss their experiences and recommendations for stopping the illegal and improper prescribing of painkilling and antipsychotic prescription drugs. Subcommittee Chairman Jay Rockefeller (D-WV) introduced legislation (S. 507) to better educate consumers about prescription drug abuse and better train doctors about prescribing controlled substances.

The Subcommittee's Ranking Member, Sen. Charles Grassley (R-IA), discussed his ongoing investigation of inappropriate prescribing patterns and state Medicaid activities to address this issue. Sen. Grassley noted the states of California, Hawaii, Iowa, Kansas, Tennessee, South Carolina, and Wisconsin were among those that had taken appropriate actions in recent years against high-prescribing outliers. However, Sen. Grassley also focused extensively on the lack of assistance to states from the Centers for Medicare and Medicaid Services (CMS).

During his testimony, Millwee noted that this is not solely a Medicaid problem. He discussed Texas' collaborative approach for addressing the challenge, which involves the Texas Health and Human Services Commission (HHSC), the Attorney General, providers, and other key entities. The five major components of HHSC's approach include prevention, education, intervention, treatment, and technology. Millwee shared some of the states' successes and, in response to questions, noted that CMS could help states by sharing successful ideas across states so that they can put them into place faster. Information from the hearing is posted at:

House Budget proposal advances. On March 29, the House of Representatives adopted (228-191) a budget plan for fiscal year (FY) 2013. The House budget resolution (H. Con. Res. 112) proposes to limit discretionary appropriations to $1.028 trillion and reform the tax code and entitlement programs. The House proposal is $19 billion below the $1.047 trillion spending cap set in the August debt limit deal (PL 112-25). The proposal includes reconciliation instructions to several committees to reduce mandatory spending by $260 billion in ten years.Â

Specifically, similar to the fiscal 2012 proposal, the House plan proposes to convert the Medicaid program into a block grant program, which would result in an $810 reduction in federal funding over the next ten years. Few details are available regarding the specific design of the proposed block grant. The proposal indicates that 1) federal funding to states would increase annually according to inflation (CPI-U) and population growth, and 2) states would be provided additional flexibility to design and administer their Medicaid programs. Analysis by the Congressional Research Services (CRS) shows that, when compared to the Congressional Budget Office projection for federal Medicaid spending, the House budget proposal would reduce federal Medicaid outlays by 17.6 percent from FY 2013 to FY 2022.

Next step: appropriations. The Senate plans to use the parameters set in last year's debt deal rather than develop a separate budget resolution for FY 2013. The $19 billion difference in the overall spending cap between the House passed budget resolution and last year's debt deal is expected to complicate the FY 2013 appropriations process. Senate leaders expect to begin marking up appropriations bills soon after Congress' two-week April recess. While both chambers plan to bring appropriations bills to the floor, Congress is unlikely to finish its appropriations work until after the next fiscal year starts Oct. 1.

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In the News

NH Transitions Medicaid to Managed Care. A bill passed by the New Hampshire Legislature last year instructs the Department of Health and Human Services to transition the state's Medicaid system to a managed care model, administered by private companies, by July 1, 2012. Lawmakers are hoping to save $16 million in the first year by transitioning to managed care. Kathleen Dunn, the state's Medicaid director, said she envisions "multiple points of contact" between DHHS and Medicaid recipients during the enrollment process, which will allow DHHS to forward information about individual patients directly to the private managed care companies.

Services will be transitioned in three phases. The first, which begins when the program launches later this year, includes payment for things like routine visits to the doctor and drug services. Twelve months later, the system will expand to encompass people who receive long-term care supports, such as people with developmental disabilities and elderly people in long-term care facilities and nursing homes. The third phase, commencing in 2014, will be the expansion of the program to include some 40,000 to 50,000 Medicaid beneficiaries made newly eligible by the Affordable Care Act, extending benefits to families living at up to 138 percent of the federal poverty level. ("Health commissioner casts doubt on July launch for Medicaid overhaul,", March 28, 2012).

Governing Continues Profile of Rhode Island's Health Insurance Exchange Implementation. Governing published the second in a series of articles about Rhode Island's implementation of its health insurance exchange. Over the last year, a call for efficiency from the federal government and stakeholder groups pushed Rhode Island officials toward creating a simpler experience for the estimated 862,000 customers that will use the exchange, where the entire infrastructure "should be invisible to the consumer," Medicaid director Elena Nicolella explained. To aid its IT decisions, Rhode Island also joined the New England States Collaborative Insurance Exchange Systems collaborative, a group of six Northeast states that are sharing ideas about how to create the technological infrastructure necessary for the insurance marketplaces. The next big step for the state is putting out requests for proposals (RFPs), which would allow IT companies to pitch their ideas for the website design and accompanying software program that will run the exchange based on Rhode Island's vision. ("Rhode Island's Health Insurance Evolution," Governing, March 23, 2012).

"The Challenge of Sustaining Medicaid: A Tragedy in Three Acts." NAMD's Matt Salo penned a piece for the Council of State Governments' online publication, Capitol Ideas. In it Salo examines the current state budget challenges and he offers a window into the short term recovery for state revenues and the long-term outlook for state budgets and state Medicaid programs. Read more at:

InsideHealthPolicy connects dots with OIG and NAMD reports. The trade publication InsideHealthPolicy recently covered key recommendations in NAMD's position paper, "Rethinking Medicaid Program Integrity: Eliminating Duplication and Investing in Effective, High-Value Tools," concerning the Medicaid Integrity Contractor (MIC) program. IHP reporter Michelle Stein also tied states' concerns to the evidence documented in the March 22nd report released by the HHS Office of the Inspector General (OIG). The OIG's investigation found that a very poor return on investments from the program. ("Medicaid Directors Question Future Of Audit MICs As OIG Slams Program," InsideHealthPolicy, March 22, 2012)

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Other Items of Interest

Florida must pay for autism therapy for poor kids, judge says. U.S. District Judge Joan Lenard, in an order signed this week, required Florida's Medicaid program to begin paying for a psychological program, called applied behavioral analysis (ABA), designed to improve the behavior, language and cognitive development of autistic children. The state already requires commercial carriers to provide the ABA therapy to Floridians with private insurance. Although the ruling impacts only Florida at the moment, it could have significant implications in the future for other states. ("Florida must pay for autism therapy for poor kids, judge says," Miami Herald, March 28, 2012).

NAMD's Salo spoke at Health Reform webinar. On March 27th, NAMD's Executive Director Matt Salo will spoke at a live webinar hosted by the Alliance for Health Reform, "Implementing Health Reform in the States." Salo was a panelist along with Noam Levy of the LATimesand Enrique Martinez-Vidal, vice president for state policy and technical assistance at AcademyHealth. A recording of the webinar is available at:

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Mark Your Calendar

NAMD State-only Spring Meeting: May 20-22, 2012, Crystal Gateway Marriott, Arlington, VA

Save the date for NAMD's 2012 Fall meeting: October 28-30, 2012, Crystal City, Marriott, Arlington, VA.

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