January 10, 2014
In This Issue
*CMS Issues Medicaid HCBS Settings Final Rule
*NASUAD: Martha Roherty Appointed as Committee Member of NQF
*NASUAD: 2013 Wrap Up Edition of the Medicaid Expansion Tracker Now Available
*NCI-AD: Georgia Kicks off National Core Indicators Project
*Aging Network Volunteer Collaborative: Got an Hour? Post Your Volunteer Opportunities and Win
*CMS: New Accountable Care Organizations Announced
*CMS Enhances Account Transfer Flat Files
*CDC: Report on Long-Term Services in the United State in 2013
*ODEP: Study on Health Care Transition and Employment
*SSA:WISE Webinar, Ticket to Work
*Congress: Budget Deal Now Law
*Congress: FY14 Appropriations Process Underway
*Congress: Budget Deal Extends Health Progrmas
*Congress: Hearing on SGR Repeal and Health Extenders
*Abt Associates: Webinar: The Intersection of Housing Policy and Health
*AAHD: Online Guide on Disability for Navigators
*Health Affairs: Analysis of Health Care Spending in the United States
*HMA: Roundtable Discussion on Exchanges and Medicaid Expansion
*NAM: Webinar: Emergency Preparedness for Older Adults and People with Disabilities
*NCOA: MIPPA Fact Sheet, Funding Update
*Events: Academy Health 2014 Health Policy Conference
*Events: AIRS 2014 Conference & Call for Proposals
*Grant: Demonstration Ombudsman Programs
*Grant: Consumer Input for Evidence-Based Healthcare
*Grant: TBI State Partnership
*Friday Updates Archive
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Breaking News

CMS Issues Medicaid HCBS Settings Final Rule

Earlier today, the Centers for Medicare and Medicaid Services (CMS) issued the Medicaid Home and Community-Based Services (HCBS) settings final rule (CMS-2249-P2).  Under development for the past several years, the final regulation addresses several sections of Medicaid law under which states may use federal Medicaid funds to pay for HCBS. In particular, the rule establishes requirements for the qualities of settings that are eligible for reimbursement for Medicaid HCBS provided under sections 1915(c), 1915(i), and 1915(k).


NASUAD is currently in the process of analyzing the regulation, and will continue to monitor any new developments.  In the interim, we encourage you to view the rule, which is on display here until its publication in the January 16 Federal Register.


Click here for the HHS press release on the final rule. 

Click here to view an HHS blog post on the final rule.

Click here to view several CMS-released Fact Sheets on the final rule.


Martha Roherty Appointed as Committee Member of NQF Alzheimer's Disease and Related Dementias

Martha Roherty, Executive Director at NASUAD, was appointed to the Prioritizing Measure Gaps:  Alzheimer's Disease and Related Dementias Committee at the National Quality Forum (NQF). She will contribute content knowledge and expertise over the course of this project, eventually leading to the production of a written report with recommendations on performance measurement priorities.


Martha will also assist with the identification of existing research, measures, and resources to detect performance measure gaps; provide feedback on a conceptual framework to assess measurement needs; and, as a part of a multi-stake holder committee, provide recommendations for prioritizing performance measurement efforts related to the Alzheimer's Disease and Related Dementias population and their caregivers.

2013 Wrap Up Edition of the Medicaid Expansion Tracker Now Available

The State Medicaid Expansion Tracker is a NASUAD publication that focuses on actions and activities around the  implementation of the Affordable Care Act's (ACA) optional Medicaid expansion. 


In June 2012, the Supreme Court found all of the ACA to be constitutional, except the application of the Medicaid expansion as a mandate.  To remedy this aspect of the law while leaving the rest intact, the Court essentially made state participation in the expansion optional by limiting the penalty for non-compliance to a loss of federal funding associated with the expansion only, rather than all of the state's Medicaid funding. 


With coverage of this new adult population now optional, state officials have spent the intervening months weighing participation in the expansion, with varying results.  To monitor state trends and progress around this issue, NASUAD has drawn from a variety of sources to compile the State Medicaid Expansion Tracker.  The final edition of 2013 includes a year-end status update of state decisions as of December 31, 2013.  We will continue to update this analysis regularly in 2014. 

National Core Indicators-Aging and Disability Project

Georgia Kicks off National Core Indicators Project

On January 8, NASUAD and Human Services Research Institute (HSRI) conducted the first interviewer training for the pilot National Core Indicators-Aging and Disabilities (NCI-AD) pilot project. The training was held in Atlanta, Georgia, with the Delmarva Foundation, the organization that Georgia Division of Aging Services has contracted with to conduct the in-person interviews in their state. 


The NCI-AD is an in-person survey tool designed to assess the quality of life and outcomes of state aging and disability service participants.  NCI-AD support states' efforts to evaluate the performance of their home and community-based service systems and improve services to better support the older adults, individuals with physical disabilities, and caregivers the system serves.   Georgia, Minnesota, and Ohio agreed to pilot the survey beginning in January 2014.  After the three pilots are complete, the survey will be revised, and the NCI-AD project will be available for any state to join in early 2015.


 Click here for more information about this project.

Aging Network Volunteer Collaborative

Got an Hour? Post Your Volunteer Opportunities to Win

The Got an Hour? Give it Back Campaign connects potential volunteers with the aging network's opportunities to help seniors. Powered by VolunteerMatch.org, the Campaign's website  GiveItBacktoSeniors.org, provides downloadable materials, webinars, and a search tool to help your agency connect to prospective volunteers in your neighborhood.
Post your organization's volunteer opportunities on VolunteerMatch.org between now and January 31, and you'll be automatically entered to win a $50 gift card. Contact Rachel Feldman at NASUAD with questions.

Click here to view contest details.
Click here for tips on how to post events.  
From the Administration
Centers for Medicare and Medicaid Services
CMS Announces New Accountable Care Organizations
Doctors, hospitals and health care providers establish Accountable Care Organizations (ACOs) in order to work together to provide higher-quality coordinated care to their patients, while helping to slow health care cost growth. Since passage of the Affordable Care Act, more than 360 ACOs have been established, serving over 5.3 million Americans with Medicare. Health and Human Services Secretary Kathleen Sebelius recently announced the formation of 123 new ACOs in Medicare, providing approximately 1.5 million more Medicare beneficiaries with access to high-quality coordinated care across the United States. The New ACOs include a diverse cross-section of health care providers across the country, including providers delivering care in underserved areas. 

Click here for a list of the new ACOs.

Click here to read the full CMS press release.

CMS Enhances Account Transfer Flat Files
Based on state feedback, the Centers for Medicare & Medicaid Services (CMS) recently made additional enhancements to the account transfer flat files that states can use to enroll individuals who have applied through the Federally Facilitated Marketplace (FFM) into Medicaid and the Children's Health Insurance Program (CHIP). These additional enhancements include data fields for income and gender to facilitate enrollment from the flat files into the proper eligibility category.


CMS also recently began sending states weekly quality assurance (QA) lists to help them identify those cases where because information is missing, or for other reasons, the quality assurance review suggests that enrollment based on the information in the flat file would not be appropriate. While CMS continues to work with states on final testing of account transfer functionality, all FFM states are strongly encouraged by CMS to consider enrolling eligible individuals based on the information now being shared with states. This is expected to expedite enrollment for individuals and help states address workload issues.


Click here for the full Center for Medicaid and CHIP Services Informational Bulletin.
Centers for Disease Control and Prevention/National Center for Health Statistics
Report on Long-Term Services in the United State in 2013

The Center for Disease Control and Prevention (CDC) and the National Center for Health Statistics (NCHS) released a report entitled, Long-term Care Services in the United States: 2013 Overview, which presents results from the first wave of a study they conducted: the National Study of Long-Term Care Providers (NSLTCP). This report provides information on the supply, organizational characteristics, staffing, and services offered by providers of long-term care services; and the demographic, health, and functional composition of users of these services. Data presented in the report are drawn from five sources: NCHS surveys of adult day services centers and residential care communities; and administrative records obtained from the Centers for Medicare & Medicaid Services on home health agencies, hospices, and nursing homes.

Office of Disability Employment Policy

Study on Health Care Transition and Employment

The Office of Disability Employment Policy (ODEP) recently released a study on health care transition and employment. The study examines the role health care providers play in establishing employment expectations. Despite growing recognition of the importance of health care transition in the overall change from school to work, and independent living within the health care community, youth with chronic health conditions and other disabilities face a number of challenges in accessing health care transition services.


Challenges reviewed in the study include low expectations, lack of time, and inadequate payment and training related to employment among providers; systems with distinct and disparate outcomes and goals; and the application of a biological/physiological versus bio-psychosocial treatment approach.


Click here to view the full policy brief.

Social Security Administration

WISE Webinar, Ticket to Work: Support for People with Disabilities on the Journey to Financial Independence

The Social Security Administration is holding a National Work Incentives Seminar Event (WISE) webinar entitled, Ticket to Work: Support for People with Disabilities on the Journey to Financial Independence.


The webinar will be held on January 22, 2014, 3:00 p.m., ET. This webinar will provide an opportunity for individuals who have previously participated in a Ticket to Work and Work Incentives webinar to learn more about the path to financial independence, and will present tips, tools, and resources that help attendees learn how to save what they earn; understand tax benefits that may apply to them; and gain basic financial knowledge such as budgeting and expense tracking.


Click here to register for the webinar online, or call 1-866-968-7842 (V) or 1-866-833-2967 (TTY). 

From Congress

Budget Deal Now Law

Before adjourning in December , Congress approved and the President signed a bipartisan budget deal, the Bipartisan Budget Act (BBA, HJ Res 59) negotiated by House Budget Chair Paul Ryan (R-Wisc.) and Senate Budget Chair Patty Murray (D-Wash.).  The President signed the bill into law on December 26.


The agreement partially rolls back the sequester for fiscal years (FY) 2014 and 2015 by increasing the Budget Control Act of 2011's (BCA) spending caps by $45 billion in FY14 and $18 billion in FY15.  Just as sequestration cuts are equally divided between defense and non-defense programs, so too is the sequestration relief provided under the BBA.


As a result of these new topline numbers, total discretionary spending in FY14 is set at $1.012 trillion.  Of this amount, $520 billion will go to defense programs, while $492 billion will be available to fund non-defense programs.  By contrast, under the Budget Control Act of 2011 (BCA, PL 112-25), FY14  discretionary spending would have been capped at roughly $967 billion: $497 for defense and $469 for non-defense.


In FY13, discretionary reductions for both defense and non-defense programs were achieved through automatic, across-the-board (ATB) cuts at the federal program level.  From FYs 2014-2021, reductions to covered discretionary programs will be achieved by lowering the BCA caps on discretionary spending each year. Funding levels for specific programs would then be set through the regular appropriations process.


Though the December budget deal increases the overall amount that appropriators will have to work with in FY14 from $967 billion to $1.012 trillion, the BBA does not alter the BCA's process for setting individual program funding levels.  That is, while the budget agreement changes overall funding levels, it does not change the process for allocating those funds.


Accordingly, in FY14, Congressional appropriators will continue to have the same discretion they always do in deciding what programs to fund and by how much.  This means that until FY14 appropriations bills are written, we will not know which programs are to receive a portion of the restored funding.  Lawmakers could choose to dole out the dollars as ATB program increases, or they could give more individualized funding boosts.   Therefore, we do not yet know how the BBA and its partial sequester relief will impact Older Americans Act funding in FY14.

FY14 Appropriations Process Underway

Passage of the Bipartisan Budget Act (BBA) cleared the way for appropriators in both chambers to begin developing FY14 spending bills that adhere to its $1.012 trillion funding level.  In allocating these dollars, Congressional appropriators will have the same discretion they always do in deciding what programs to fund and by how much.  Accordingly, until FY14 appropriations bills are written, we will not know which programs will receive a portion of the restored funding. 


The top appropriators in both chambers have been consistently vocal about their preference for an omnibus spending package - a single measure that incorporates all 12 appropriations bills and sets funding levels for the remainder of FY14.  They hope to bring such a bill to the floor before the current Continuing Resolution (CR, PL 113-46) expires on January 15.


In anticipation of this quick turnaround, Appropriations Chairmen Sen. Barbara A. Mikulski (D-Md.) and Rep. Harold Rogers (R-Ky.) allocated the BBA-set funding levels among the 12 appropriations subcommittees shortly after the deal was unveiled last month.   These individualized funding levels, known as 302(b) allocations, are the numbers that lawmakers are using to write their respective FY14 spending bills. We do not know the topline number assigned to any of the subcommittees, as the 302(b)s are being closely held, and are expected to remain so until the omnibus reaches the floor.  


While details around the content of the  12 bills remain scarce, we do know that at least six have been successfully negotiated, with two more nearing completion.  Still outstanding are the more politically divisive bills, including the Labor, Health and Human Services, Education, and Related Agencies measure, which funds many health programs including the Older Americans Act.


Despite the ongoing negotiations, it became increasingly clear on Friday morning that appropriators would have difficulty meeting the January 15 deadline, in part due to procedural hurdles.  Accordingly, Rep. Rogers filed a three-day CR to keep the federal government open through January 18, buying appropriators more time to  resolve any remaining issues.   In so doing, Rep. Rogers clarified that the need for a CR does not suggest an impasse on the omnibus talks, and expressed his optimism that the 12-bill spending package would be released next week. Both chambers are expected to consider the CR in the coming days.

Budget Deal Extends Health Programs, Doc Fix for Three Months

In addition to providing temporary, partial sequester relief for two years, the Bipartisan Budget Act (BBA) blocked a 23.7 percent cut to Medicare reimbursements for physicians that was scheduled to begin on January 1.  To prevent these cuts, which would have been required in order to meet the sustainable growth rate (SGR), the package includes a short-term "doc fix," which increases current rates by 0.5 percent through March 2014.  The agreement also temporarily extends more than a dozen Medicare-related programs, which are often addressed in year-end legislation along with the doc fix.


Among these so-called 'extenders' is $12.5 million over the first three months of 2014 for outreach and enrollment assistance to low-income Medicare beneficiaries.  This amount includes $3.75 million each for Area Agencies on Aging and State Health Insurance Assistance Programs, $2.5 million for Aging and Disability Resource Centers, and $2.5 million to contract with the National Center for Benefits and Outreach Enrollment. 


Lawmakers hope this short-term doc fix patch will give them time to finish work on a more permanent replacement measure, which may also include longer-term health program extenders. 

Congressional Hearing on SGR Repeal and Health Extenders

On January 9, the House Energy and Commerce Health Committee held a hearing to examine a number of these health programs, and how they should be handled in connection with a possible overhaul of the Medicare physician payment formula.


With a three-month 'doc fix' and extenders package set to expire this spring, committees in the House and Senate continue to work on legislation (S. 1871, H.R. 2810) to permanently repeal and replace the physician reimbursement rate, known as the sustainable growth rate (SGR) formula.


The focus of Thursday's hearing was to examine the health programs that have traditionally been extended each year along with the SGR, and to evaluate how they should be handled in connection with a possible congressional overhaul of the Medicare physician payment system.


Click here to view the archived video of the hearing. 

From Other Organizations
Abt Associates

Webinar: The Intersection of Housing Policy and Health

Abt Associates is hosting a webinar with entitled, Olmstead is the Mandate, ACA the Opportunity, to explore ways that linking community-based housing to health services can better serve the most vulnerable populations. The webinar will be held January 24, 2014, 12:30 p.m. to 2:00 p.m. ET. Some of the nation's leading experts from federal and state agencies and policy organizations will present during the webinar:

  • Alison Barkoff, Special Counsel for Olmstead Enforcement in the Civil Rights Division of the Department of Justice.

  • Dan Burke, Director, Chicago Multifamily HUB, U.S. Dept. of Housing and Urban Development

  • Jill Khadduri, Senior Fellow and Principal Associate in Housing & Communities Practice, Abt Associates

  • Gretchen Locke, Senior Associate, Housing & Communities Practice, Abt Associates

  • Kevin Martone, Executive Director, Technical Assistance Collaborative

  • Danna Mauch, Senior Fellow and Principal Associate in U.S. Health Division, Abt Associates

  • Charles Milligan Jr., Deputy Secretary for Health Care Financing, overseeing the Medicaid program and ACA activities for the State of Maryland

 Click here to register for the webinar. 

American Association on Health and Disability

New Online Guide on Disability for Marketplace Navigators

The American Association on Health and Disability (AAHD) announced the publication of a technical assistance guide for the National Disability Navigator Resource Collaborative (NDNRC). The Guide to Disability for Healthcare Insurance Marketplace Navigators is designed to inform navigators and other enrollment specialists about special considerations people with disabilities face as they shop for healthcare coverage.


The NDNRC is an initiative aimed at providing cross-disability information and support to Navigators and other enrollment specialists thereby ensuring people with disabilities receive accurate information when selecting and enrolling in insurance through the Affordable Care Act Marketplaces. The recently launched website  also has news and resources designed to support groups who are providing enrollment assistance to consumers with disabilities as they enroll for coverage through the marketplaces. The NDNRC is funded through a grant from the Robert Wood Johnson Foundation.

Health Affairs

Analysis of Health Care Spending in the United States

The January 2014 issue of Health Affairs recently released an analysis on health care spending from the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS). The analysis estimates that health care spending in the United States grew at a rate of 3.7 percent in 2012 to $2.8 trillion. That level of annual growth is similar to spending growth rates since 2009, which increased between 3.6 percent and 3.8 percent annually. This implies that growth during all four years has occurred at the slowest rates ever recorded in the fifty-three-year history of the National Health Expenditure Accounts.


Click here to access the Health Affairs article.

Health Management Associates

Roundtable Discussion on Exchanges and Medicaid Expansion

Health Management Associates (HMA) presents an Expert Roundtable Discussion entitled, Exchanges and Medicaid Expansion: What happened, what's on the horizon, and what it all means. The event will be held on January 15, 2014, 1:00 p.m. to 2:00 p.m. ET.


The following topics will be covered in the discussion: 

What's taking place in states operating Exchanges; Approaches states are taking as they expand - or opt not to expand - Medicaid; The Federally Facilitated Marketplace - from state experiences to technical nuts and bolts; How the 2014 elections might change the landscape even more; and Health plan strategies for participation in Exchanges.


Roundtable experts will include: Joan Henneberry, Denver; Mike Nardone, Harrisburg; Wade Miller, Atlanta; Greg Nersessian, New York.


Click here to register for this free event. 

National Center for Health and Aging

Webinar: Emergency Preparedness for Older Adults and People with Disabilities

The National Center for Health and the Aging, a project of North American Management, is hosting a webinar entitled, Keeping Older Americans and People with Disabilities Safe and Healthy in Emergencies. The webinar will be held on January 13, 2014, 1:00 p.m. to 2:00 p.m. ET.   

Kathleen Otte, Regional Administrator at the Administration on Aging, will present the webinar. Participants will be given instructions on how to enter the meeting room, as well as dial-in information after completing the registration process. Due to a limited amount of space available on Go-To-Webinar, participants are urged to log in 5-10 minutes before the start of the webinar.


Click here to register for the webinar. 

Email Rachel.logan@namgt.com with questions.

National Council on Aging

MIPPA Funding Updates

The Center for Benefits Access at the National Council on Aging (NCOA) released a fact sheet on Medicare Improvements for Patients and Providers Act (MIPPA) funding updates. The fact sheet reports that Congress passed a budget agreement in December that included additional $12.5 million in MIPPA funding in FY14 to Area Agencies on Aging (AAAs) ($3.75 million), State Health Insurance Assistance Programs (SHIPs) ($3.75 million), and Aging and Disability Resource Centers (ADRCs) ($2.5 million), as well as the Center for Benefits to support them ($2.5 million). In addition, the sustainable growth rate (SGR) bill, also known as the "doc fix," was passed by the Senate Finance Committee in mid-December including a provision to permanently appropriate current level funding ($25 million each fiscal year) for low income outreach and assistance activities under MIPPA.


During the first two MIPPA grant periods (2009-2012), SHIPs, AAAs and ADRCs submitted more than 690,000 applications for Low Income Subsidy (LIS) and Medicare Savings Programs (MSPs), worth a combined $1.9 billion in benefits, according to the Center for Benefits Access.


Click here to access the full MIPPA fact sheet. 


Academy Health 2014 National Health Policy Conference

Academy Health is holding their 14th National Health Policy Conference (NHPC) from February 3-4 in Washington DC. The conference is designed to provide a comprehensive outlook on the nation's health policy agenda, clarity on critical health care issues, and policy priorities for the upcoming year. Topics will include Affordable Care Act (ACA) implementation with feedback from state government officials, insight from the administration and Congress, and viewpoints from the private sector. 


Click here for more information and to register for the conference. 

AIRS 2014 Conference and Call for Proposals

The Alliance of Information and Referral Systems (AIRS) 2014 Conference will be held from June 1-4 in Atlanta, GA. AIRS is accepting conference proposals from now through March 1, 2014.


NASUAD is coordinating the Aging and Disability Track again this year, and is seeking proposals on the following topics: Quality Assurance; ADRC/211 partnerships; Mental health needs; Homelessness and aging/disability; Aging with intellectual disabilities; Options Counseling; Medicaid Managed Care; Reaching hard-to-reach communities: LGBT, minority groups, immigrants, etc.; Use of technology for online events, fundraising and social media... And other ideas you may have.


Contact Sara Tribe, manager of the AIRS Conference Aging and Disability Track, with questions or to discuss proposal ideas.


Click here for more information on the conference, and to access the proposal application.
Funding Opportunities
Demonstration Ombudsman Programs

Full Title: Support for Demonstration Ombudsman Programs Serving Beneficiaries of Financial Alignment Models for Medicare-Medicaid Enrollees

Issuing Agency: Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services

Eligible Applicants: State governments

Funding Level: $3,000,000 to $275,000

Close Date: January 13, 2014, 3:00 p.m. ET

Funding Opportunity Number: CMS-1J1-13-001

CFDA Number: 93.634 

Description:  This Funding Opportunity will provide financial assistance over a three-year period to States to plan, develop and provide Demonstration Ombudsman Program services to individuals who participate in the Financial Alignment model. In providing an Ombudsman Program, States will ensure that individual beneficiaries have access to person-centered assistance in resolving problems related to the Demonstration. In addition, a Demonstration Ombudsman Program will inform States, Plans, CMS, and other stakeholders regarding beneficiary experience with the Plans and will recommend areas of improvement in States' Financial Alignment Initiatives. Applications must be submitted via Grants.gov.


Click here for more information on this grant opportunity, and to access the grant announcement.  
Consumer Input for Evidence-Based Healthcare

Full Title: Deliberative Approaches: Patient and Consumer Input for Implementing Evidence-Based Health Care (R21)

Issuing Agency: Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services

Eligible Applicants: State governments; Native American tribal governments and organizations; County governments; City or township governments

Funding Level: $200,000

Close Date: February 7, 2014, 5:00 p.m. local time

Funding Opportunity Number: RFA-HS-14-007

CFDA Number: 93.226


Description:  Deliberative methods offer means to gain insight into patient and public views that can inform and improve clinical, program, and policy decisions in health care. The purpose of this Funding Opportunity Announcement (FOA) is to use deliberative methods to understand and clarify important public or patient values and concerns that affect the implementation of specific interventions, programs or policies to improve health care or research. Applications must be submitted via Grants.gov.

Click here for more information on this grant opportunity, and to apply. 
Traumatic Brain Injury State Implementation Partnership Grant

Issuing Agency: Health Resources & Services Administration (HRSA) 

Eligible Applicants: State governments, County governments, Native American tribal governments and organizations

Estimated Total Funding Level (not per grant):

Posted Date: January 9, 2014

Close Date: March 7, 2014

Funding Opportunity Number: HRSA-14-019

CDFA Number: 93.234

Description: The purpose of the HRSA TBI program is to increase access to rehabilitation and other services for individuals with traumatic brain injury (TBI).  The goal of the this funding opportunity announcement (FOA) is to support State, Territorial governments, Federally recognized Indian Tribal governments and Native American organizations as they address barriers to needed services encountered by children, youth, and adults with and at high risk for TBI.


Applications must be submitted via Grants.gov.

Friday Update Archive


Did you miss a previous issue?  

Check out past Friday Updates.