--In 2011, payments to states will be prohibited for costs resulting from health care-acquired conditions. This does not affect access to care or services for the Medicaid patient.

--Starting this year, states that provide home and community-based services may expand service eligibility, as long as individual income does not exceed 300 percent of the maximum supplemental security income benefit rate. States may offer more types of home and community-based services to those with a higher needs-level under a state plan amendment. Services can be targeted to specific populations.


Administration

--Starting this year through 2012, HHS will choose five states for a global payment demonstration project, in which a participating state will change payments to a safety-net hospital from fee-for-service to a global capitation payment model. In capitation, a flat amount is paid to the provider per individual per month. The percentage of those patients who do not use a provider's care is supposed to balance those with a high utilization rate.

--The Medicaid and CHIP Payment and Access Commission, which reviews payment policies in the programs, will be expanded to include assessment of adult services, including for those dually eligible for Medicare and Medicaid.

--Prior to the PPACA, institutions for mental illness were not allowed to receive Medicaid reimbursement for emergency services. However, HHS will now establish a three-year demonstration project in up to eight states to reimburse these institutions for emergency services for beneficiaries between 21 and 65.

--HHS will establish a Centers for Medicare and Medicaid Services innovation center. The purpose is to test innovative payment and delivery models to reduce costs. Models for care will focus on populations with deficits in care, such as women's health and seniors' health. Patent-centered medical home models will be reviewed. Measures will be considered for the chronically ill, including care coordinators, a chronic disease registry, and home telehealth technology. Payment models will transition from fee-for-service to comprehensive payment or salary-based payment. A varying payment system will be considered for physicians who order advanced diagnostic images, according to criteria for appropriateness. Those criteria will be determined through consultation with physician specialty groups and stakeholders.

Oversight

--The period for a state to collect overpayment of Federal Medicaid funds is extended from 60 days to one year. States must correct federally-identified claims of overpayment of an ongoing or recurring nature with new Medicaid Management Information System (MMIS) audits or other corrective actions. States will report an expanded set of data elements under MMIS to detect fraud and abuse. There is now a mandatory state use of National Correct Coding Initiative methodology.

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