Mandates to Medicaid The Future of Health Care State Bar of - - PowerPoint PPT Presentation
Mandates to Medicaid The Future of Health Care State Bar of California, Business Law Section Health Care Committee T eleseminar: February 1, 2013 9:00 AM Presented by Craig B. Garner PAGE: 1 Mandates to Medicaid The Future of Health Care
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T eleseminar:
February 1, 2013 9:00 AM Presented by Craig B. Garner
State Bar of California, Business Law Section Health Care Committee
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Mandates to Medicaid
The Future of Health Care
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The Future of Health Care
Statutory Authority
(Pub. L. 111-173) = ________________________________
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The Future of Health Care
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What Satisfies the Mandate?
, Tricare, Veterans, Peace Corps); or
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The Future of Health Care
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The Penalty
Minimum Essential Coverage? Exception?
PENALTY (in 2016) the greater of $695 (or less)
Yes No No Yes
not to exceed
Bronze Level of Coverage
2.5% of household income
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The Future of Health Care
Collecting the Penalty
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The Future of Health Care
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The Future of Health Care
What Are Essential Health Benefits?
42 U.S.C. § 18022
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The Future of Health Care
What Could Be Essential Health Benefits?
Institute of Medicine, Essential Health Benefits
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The Future of Health Care
What Are the Levels of Coverage?
42 U.S.C. § 18022(d), (e)
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The Future of Health Care
Precious Metals (January 2013)
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The Health Insurance Marketplace is designed to help you find insurance that fits your budget, with less hassle. No matter where you live, you’ll be able to buy insurance. . . . New laws mean plans must treat you fairly and can’t deny you coverage because of pre-existing conditions. Source: CMS T
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How Do Exchanges Work?
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State-Based Exchange
Each individual state operates all Exchange activities, but a state may use federal government services for the following activities:
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The Future of Health Care
State Partnership Exchange
State operates activities for:
State may elect to perform or can use federal government Services for the following activities:
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Federally-Facilitated Exchange
HHS operates, but state may elect to perform or can use federal government services for the following activities:
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Exchange Transparency
As part of the application process, each state should post certain sections from its application on the appropriate state website, including:
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California Health Benefit Exchange
The California Health Benefit Exchange posts the following vision, mission and values on its website (www.healthexchange.ca.gov):
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The Future of Health Care
New Regulations To Ensure Fairness
But what is tobacco use?
Are there capacity limits?
Who will conduct the reviews?
Who will monitor?
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The Future of Health Care
Statutory Authority for Medicaid
_____________________________ 42 U.S.C. § 1396d
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The Future of Health Care
What Is Medicaid?
Health insurance for individuals who qualify financially, as well as families with dependent children, the aged, blind or disabled.
ennCare
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The Future of Health Care
Medi-Cal
Assembly and Senate $240,600)
“The purpose [of Medi-Cal] is to afford to qualifying health care and related remedial
those receiving health care under [Medi-Cal].”
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Medicaid Expansion
77 Federal Register 17144 (Mar. 23, 2012) (Final Rule)
Affordable Care Act related to Medicaid eligibility, enrollment and coordination with the Exchanges, CHIP , and other programs
minimum Medicaid income eligibility level of 133 percent of the Federal Poverty Level for most non-disabled adults under age 65 Proposed Rule (Jan. 14, 2013)
changes to provide states more flexibility to coordinate Medicaid and CHIP eligibility, appeals and other administrative procedures
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Medicaid Expansion and the Supreme Court
Supreme Court held that Congress has the authority to offer funding for states to expand Medicaid by 2014 without imposing retroactive financial conditions. National Fed. of Indep. Bus. v. Sebelius, 132 S. Ct. 2566, 2606-07 (2012).
dreamed that any State would refuse to go along with the expansion of
(Scalia, Kennedy, Thomas and Alito, JJ, dissenting).
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Medicaid Expansion (Nov. 2012)
Not Participating Leaning T
Undecided Participating Leaning T
es
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The Future of Health Care
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Medicaid Expansion (Jan. 2013)
After Election refers to views as of January 13, 2013. In states with newly elected governors, before election refers to the views of the outgoing governor, and after election refers to the views of the governor-elect. Source: Sommers, U.S. Governors and the Medicaid Expansion, New
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Medicaid Expansion By the Numbers
beneficiaries through 2016, 95% in 2017, 94% in 2018, 93% in 2019 and 90% in 2020 and thereafter.
starting in 2013.
instances specialists) provided (1) they are Board-certified or (2) at least 60% of the Medicaid codes they billed in the previous year were primary care codes identified in the Affordable Care Act.
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Questions?
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