Federal Healthcare Initiative: Medicaid Initiative Timeline

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Developed by CSG's Healthcare Centers of Excellence, the Medicaid Initiative Timeline provides a comprehensive view of HITECH, ACA, HIPAA and Eligibility Final Rule requirements to aid your strategic planning initiatives. Click on any item for a summary description of the requirement and additional links to related sources.

The timeline is updated as requirements change and initiatives evolve. Your insight is also appreciated. Email suggestions for additions and/or improvements to Andrea Danes at adanes@csgdelivers.com.

2010

2011

2012

2013

2014

2015

2016

2017

2018

2019

2020

2021

2010

Action Items

Jan 1 340B Prescription Drug Discount Program Expansion
340B Prescription Drug Discount Program Expansion
Effective Date: January 1 2010
PPACA expands the list of covered entities eligible to receive 340B discounts to include

(1) certain children’s and free-standing cancer hospitals excluded from the Medica...
Jan 1 Drug Rebate Changes
Drug Rebate Changes
Effective Date: January 1 2010
Beginning January 1, 2010, health reform law increases the flat rebate percentage used to calculate Medicaid's basic rebate rate from 15.1% to 23% and from 11% to 13% for generic drugs. ...
Jan 1 Home Health Services Certification Requirement
Home Health Services Certification Requirement
Effective Date: January 1 2010
To reduce fraud, waste, or abuse, after January 1, 2010, physicians must have a face-to-face meeting with an individual before issuing home health services certification or recertification.
...
Jan 1 MCO Data in MMIS for Program Integrity
MCO Data in MMIS for Program Integrity
Effective Date: January 1 2010
Beginning on January 1, 2010, PPACA requires states to collect and submit through their MMISs managed care data as identified by the Secretary for program integrity, program oversight, and admin...
Jan 1 MCO Identification of Performing Physician
MCO Identification of Performing Physician
Effective Date: January 1 2010
For contract years beginning on or after January 1, 2010, Medicaid Managed care programs must be able to identify the physician who delivered the service and report this information through the ...
Jan 1 Medicaid Coverage: Pregnant Women
Medicaid Coverage: Pregnant Women
Effective Date: January 1 2010
State Medicaid programs can provide counseling and pharmacotherapy for ceasing use of tobacco products by pregnant women.
Mar 23 CHIP Eligibility: Prohibition
CHIP Eligibility: Prohibition
Effective Date: March 23 2010
Prohibits states from applying more restrictive CHIP eligibility standards than those under this Act before the end of FY 2019.
Mar 23 Family Planning Eligibility
Family Planning Eligibility
Effective Date: March 23 2010
States are permitted to provide family planning services through a Medicaid state plan amendment to certain low-income individuals who are not eligible for traditional Medicaid through special w...
Mar 23 Medicaid Coverage: Birth Services Expansion
Medicaid Coverage: Birth Services Expansion
Effective Date: March 23 2010
The law requires Medicaid coverage of free-standing birthing centers. States are required to pay providers such as nurse midwives and birth attendants for prenatal labor and delivery in bi...
Apr 1 Medicaid Expansion: 133% FPL
Medicaid Expansion: 133% FPL
Effective Date: April 1 2010
Inception of the State Option to expand eligibility to certain non elderly individuals (under 65) with family incomes at or below the 133% of FPL, these newly eligibles will be funded by the fed...
Oct 1 Expansion of HCBS
Expansion of HCBS
Effective Date: October 1 2010
States have the option to extend HCBS to Medicaid beneficiaries under the HCBS state plan option of the Social Security Act. This new state plan option could only be extended t...
Oct 1 FUL Modifications
FUL Modifications
Effective Date: October 1 2010
The PPACA requires the Secretary to set Federal Upper Limits (FUL) at 175% or more of the weighted average of most recently reported monthly Average Manufacturers Price (AMPs). The law als...
Oct 1 HCBS: Community First Choice Option
HCBS: Community First Choice Option
Effective Date: October 1 2010
Beginning October 1, 2010, health reform allows states to offer home and community based attendant services as an optional benefit to Medicaid beneficiaries whose income does not exceed 150% FPL...
Oct 1 LTC: Support for HCBS
LTC: Support for HCBS
Effective Date: October 1 2010
States must develop systems designed to be responsive to the changing needs of long-term care beneficiaries receiving home and community based services. State must design systems that prov...
Oct 1 NCCI Methodologies for Medicaid
NCCI Methodologies for Medicaid
Effective Date: October 1 2010
Beginning with claims submitted on October 1, 2010, PPACA requires states to add to their MMISs pre-payment edits to correct and control improper coding, similar to the NCCI edits used by Medica...
Dec 17 CMS Tax Disregard for Medicaid and CHIP
CMS Tax Disregard for Medicaid and CHIP
Effective Date: December 17 2010
Section 728 of this Act disregards federal tax refunds or advance payments with respect to a refundable tax credit, received after December 31, 2009, as income and as resources (for a period of ...
Dec 31 Recovery Audit Contractor (RAC) Program Changes
Recovery Audit Contractor (RAC) Program Changes
Effective Date: December 31 2010
PPACA requires states to establish by December 31, 2010 contracts, consistent with state law, and similar to the contracts the Secretary has established for the Medicare RAC program, with one or...
ACA: Benchmark Benefit Packages
ACA: Benchmark Benefit Packages
Health reform law modifies benchmark benefit packages available under Medicaid. From April 1, 2010 until January 1, 2014 states have the option for modifying benefit packages. However as of Janu...
Medicaid Expansion: 133% FPL
Medicaid Expansion: 133% FPL
Inception of the State Option to expand eligibility to certain non elderly individuals (under 65) with family incomes at or below the 133% of FPL, these newly eligibles will be funded by the fed...

Informational Items

Apr 23 Demonstrations and Grant Funding - Money Follows the Person
Demonstrations and Grant Funding - Money Follows the Person
Effective Date: April 23 2010
Competitive grants awarded to states under the Money Follows the Person (MFP) Rebalancing Demonstration to increase the use of home based long-term care services, eliminate barriers and increase...
Sep 23 Provider Enrollment Screening Procedures
Provider Enrollment Screening Procedures
Effective Date: September 23 2010
Deadline for suppliers and providers not enrolled in Medicaid, Medicare or CHIP at the time of enactment to comply with new enrollment screening procedures. Requires providers and supplier...
Medicaid Global Payment System Demonstration Project
Medicaid Global Payment System Demonstration Project
The Secretary is required to establish the Medicaid Global Payment System Demonstration project in no more than five states. The demonstration is required to be operational from FY 2010 through ...

2011

Action Items

Jan 1 Health Homes for Enrollees with Chronic Conditions
Health Homes for Enrollees with Chronic Conditions
Effective Date: January 1 2011
A medical home provides patients with access to primary care provider and is thought to improve patient health outcomes. PPACA establishes a new Medicaid state plan option beginning Januar...
Jan 1 HIPAA: NPI on All Transactions
HIPAA: NPI on All Transactions
Effective Date: January 1 2011
Health care providers often have multiple provider numbers, one number for billing each private insurance plan or public health care program. The administrative simplification provisions of Heal...
Jan 1 Special FMAP Adjustment for States Recovering from a Major Disaster
Special FMAP Adjustment for States Recovering from a Major Disaster
Effective Date: January 1 2011
PPACA provides for additional FMAP above the regular FMAP levels for qualifying "disaster-recovery FMAP adjustment" states once the ARRA adjustment is no longer in effect. Beginning Ja...
Jan 3 EHR Incentive: States Launch
EHR Incentive: States Launch
Effective Date: January 3 2011
Registration begins for the Medicare EHR incentive program. States that are ready may launch their Medicaid EHR incentive programs including issuing incentive payments to eligible provider...
Apr 14 Enhanced Funding: Seven Standards and Conditions (SSC)
Enhanced Funding: Seven Standards and Conditions (SSC)
Effective Date: April 14 2011

States HIT projects will be examined over the course of the SDLC to allow initial and ongoing approval of enhanced funding based on seven conditions and standards (SSC). The ...
Jul 1 Payment Adjustments for Health Care -Acquired Conditions
Payment Adjustments for Health Care -Acquired Conditions
Effective Date: July 1 2011
PPACA requires that States identify practices that prohibit payment for health care acquired conditions to incorporate into regulations these practices that are applicable to Medicaid. The...
Jul 1 Payments to Territories
Payments to Territories
Effective Date: July 1 2011
US territories that do not elect to establish an exchange as of the specified date are entitled to an increase in their existing Medicaid funding caps. for the period beginning July 1 2011...
Oct 1 DSH Payments
DSH Payments
Effective Date: October 1 2011
Under Medicaid states are required to make DSH adjustments to payment rates to hospitals treating large numbers of low income and Medicaid patients. The PPACA reduces state DSH allotments ...
Oct 1 HCBS: Community First Choice Option Proposed Rule Change
HCBS: Community First Choice Option Proposed Rule Change
Effective Date: October 1 2011
The proposed rule change would provided enhanced federal match will be available to provide “person-centered” home and community-based attendant services and supports to help increas...
ACA: Strategy Analysis
ACA: Strategy Analysis
The PPACA creates many changes and if not already underway state Medicaid programs need to begin making changes now. State Medicaid programs should thoroughly review the PPACA and identify any c...
CHIP Eligibility: Tax Credits
CHIP Eligibility: Tax Credits
Reduces CHIP eligibility for targeted low-income children are eligible for tax credits in the Health Insurance Exchanges. States must establish procedures to determine eligibility for medical as...
EHR Incentive: 2011 Reporting
EHR Incentive: 2011 Reporting
Reporting year begins for eligible professionals.
EHR Incentive: PAPD
EHR Incentive: PAPD
States should have prepared PAPDs for planning activities related to Electronic Health Record (EHR) development. With an approved PAPD, states should have conducted an environmental scan and dev...
EHR Incentive: Payments Begin
EHR Incentive: Payments Begin
EHR Incentive Payments expected to begin.
EHR Incentive: Programs Launch
EHR Incentive: Programs Launch
For Medicaid providers, states may launch their programs if they so choose. Registration for the Medicare EHR Incentive Program begins.
Health Exchange Qualified Health Plan CHIP Comparability
Health Exchange Qualified Health Plan CHIP Comparability
The Secretary will be required to review the benefits offered for children and the associated cost-sharing for exchange plans, and must certify that such plans have been determined to be at leas...
HIPAA 5010
HIPAA 5010
At this point States should have completed and submitted a Planning Advanced Planning Document (PAPD) to the CMS regional office to receive enhanced federal financial participation (FFP) for the...
HIPAA 5010
HIPAA 5010
On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010 for small health plans. All covered entities have to be fully compliant with...
HIPAA: 5010/NCPDP Testing
HIPAA: 5010/NCPDP Testing
At this point States should have completed and submitted a Planning Advanced Planning Document (PAPD) to the CMS regional office to receive enhanced federal financial participation (FFP) for the...
HIPAA: ICD-10 Level I Compliance
HIPAA: ICD-10 Level I Compliance
States should have completed planning activities, performed an Impact Analysis, developed a remediation strategy, finalized and have an approved IAPD. States should begin developing change reque...
HIPAA: ICD-10 Planning
HIPAA: ICD-10 Planning
A PAPD for ICD-10 planning efforts should have been completed and approved. By June 2011, States should have completed planning activities, performed an Impact Analysis, developed a remediation ...
HIPAA: Level II Compliance
HIPAA: Level II Compliance
At this point States should have made system changes needed to implement the 5010 standards and achieved level II compliance (When a covered entity is in compliance with Level 2, it has complete...
HIPAA: NCPDP D.0 - Level II Compliance
HIPAA: NCPDP D.0 - Level II Compliance
States should have reached Level II Compliance. Level II compliance means that a covered entity has completed end-to-end testing with each of its trading partners, and is able to ope...
Medicaid Claims Data in Federal Repository
Medicaid Claims Data in Federal Repository
CMS must include Medicaid Claims and payment data in an Integrated Data Repository that contains information from other federal programs for the purposes of identifying fraud waste and abuse.
Medicaid Coverage: Children Receiving Hospice Care
Medicaid Coverage: Children Receiving Hospice Care
PPACA allows payment for services provider to Medicaid children who voluntarily elect to receive hospice services without effecting payment for other services related to the child's terminal...
Medicaid Exclusions
Medicaid Exclusions
No Medicaid client or Medicaid provider can own, control, manage or be an affiliate of, an entity that has not repaid overpayments, is suspended, excluded or terminated from the Medicaid program...
Medicaid Payment Restrictions
Medicaid Payment Restrictions
State Medicaid programs cannot make payments to any financial institution or entity outside of the United States.
Medicaid Program Integrity Changes
Medicaid Program Integrity Changes
An additional $10 million is added for Health Care Fraud and Abuse Control for FY 2011-FY2020. Along with the additional funding, to insure it has all the information necessary in the prev...
Provider and Client Termination Requirements
Provider and Client Termination Requirements
State Medicaid programs must terminate clients or providers if they are terminated from Medicare or from another State Medicaid program.
Provider Enrollment Changes
Provider Enrollment Changes
State Medicaid programs must enroll any billing agent, clearinghouse or other payees that submit claims on behalf of enrolled providers.
Standard Enrollment Application Form
Standard Enrollment Application Form
The Secretary is required to establish a system to ensure that individuals who apply for health insurance coverage through an exchange and are found to be eligible for Medicaid or CHIP are enrol...

Informational Items

Jan 1 Creation of a Center for Medicare and Medicaid Innovation
Creation of a Center for Medicare and Medicaid Innovation
Effective Date: January 1 2011
By January 1, 2011, the HHS Secretary must establish a Center for Medicare and Medicaid Innovation to test innovative payment and delivery models that will reduce spending under Medicare, Medica...
Jan 1 Grants to State Medicaid Agencies for Lowering Health Risks
Grants to State Medicaid Agencies for Lowering Health Risks
Effective Date: January 1 2011
By January 1, 2011 the HHS secretary must award grants to States to provide incentives to Medicaid beneficiaries to participate in programs that promote healthy lifestyles. State Medicaid ...
Jan 1 Increased Medicare Coverage for Prevention Services
Increased Medicare Coverage for Prevention Services
Effective Date: January 1 2011
The Medicare program will provide coverage of personalized prevention plan services, including a health risk assessment. Also prohibits cost-sharing for such services.
Feb 25 ACA: Maintenance of Effort (MOE) provisions are flexible
ACA: Maintenance of Effort (MOE) provisions are flexible
Effective Date: February 25 2011
Secretary Sebelius identifies three eligibility groups that are excluded from the PPASCA MOE provision. The MOE clarifications include (1) excluded higher-income adult populations, (2) exc...
Feb 25 Innovation Waivers Regulations
Innovation Waivers Regulations
Effective Date: February 25 2011
The PPACA provides significant implementation flexibility to states, from how they design Exchanges to cracking down on the worst of insurance company abuses. For example, if States choose...
Mar 1 ACA: Controls costs for early retiree coverage
ACA: Controls costs for early retiree coverage
Effective Date: March 1 2011
As of December 31, 2010, more than 5,000 employers had been accepted into ERRP, more than $535 million in health benefit costs have been reimbursed through the program, and those payments have h...
Mar 1 New Information on Nursing Home Website
New Information on Nursing Home Website
Effective Date: March 1 2011
The Nursing Home Compare Medicare website (need the link) will now have information on nursing homes including: staffing data and information on instances of criminal violations by a nursing fac...
Apr 1 EHR Incentive: Medicare EHR Attestation Program Begins
EHR Incentive: Medicare EHR Attestation Program Begins
Effective Date: April 1 2011
Attestation for the Medicare EHR Incentive Program begins.
Apr 29 CMS Oral Health Strategy
CMS Oral Health Strategy
Effective Date: April 29 2011
After several months of collaboration with State and federal partners and stakeholder organizations, CMS has released a strategic document to improve access to oral health services. This d...
Apr 29 Increased Funding for CHIP and Medicaid Translation and Interpretation Services
Increased Funding for CHIP and Medicaid Translation and Interpretation Services
Effective Date: April 29 2011
The intent is to encourage States to provide services to qualifyng individuals. Provision of these services to non-qualifying individuals will be matched at the standard administrative rat...
Apr 29 National Background Checks Funding Opportunity
National Background Checks Funding Opportunity
Effective Date: April 29 2011
CMS issued Federal matching fund grant for National Background Checks for direct patient access employees of long term care facilities and providers. Proposals are due in late June 2011.
Apr 29 Value-Based Purchasing Will Reward Hospitals Based on Quality of Care for Patients
Value-Based Purchasing Will Reward Hospitals Based on Quality of Care for Patients
Effective Date: April 29 2011
On April 22, 201, CMCS clarified the nonapplicability of the appeals component of the five National Correct Coding Initiative (NCCI) methodologies. CMS has determined that the appeals component ...
May 1 EHR Incentive: Medicare EHR Payments Begin
EHR Incentive: Medicare EHR Payments Begin
Effective Date: May 1 2011
In May 2011, HHS will start issuing incentive payments to Medicare providers that implement, adopt or enhance their EHR systems.
May 2 Medicaid Prevention Grants
Medicaid Prevention Grants
Effective Date: May 2 2011
CMCS, in conjunction with the Office of Research, Development, and Information, is pleased to announce the invitation to States to apply for participation in the Medicaid Incentives for Preventi...
Jul 3 EHR Incentive: Qrtly Hosp MU Reporting
EHR Incentive: Qrtly Hosp MU Reporting
Effective Date: July 3 2011
Last day for eligible hospitals to begin their 90-day reporting period to demonstrate meaningful use for the Medicare EHR Incentive Program.
Sep 30 EHR Incentive: Federal FY Ends
EHR Incentive: Federal FY Ends
Effective Date: September 30 2011
Last day of the federal fiscal year. Reporting year ends for eligible hospitals and CAHs.
Oct 1 Adult Health Quality Measures
Adult Health Quality Measures
Effective Date: October 1 2011
The law adds a federal initiative to collect and report on quality of care data for adults enrolled in Medicaid. Within one year after the release of quality measures, the Secr...
Nov 30 EHR Incentive: 2011 Hosp Regist Deadline
EHR Incentive: 2011 Hosp Regist Deadline
Effective Date: November 30 2011
Last day for eligible hospitals and critical access hospitals to register and attest to receive an Incentive Payment for Federal fiscal year (FY) 2011.
Dec 31 EHR Incentive: 2011 CY End
EHR Incentive: 2011 CY End
Effective Date: December 31 2011
Calendar 2011 payment year ends for eligible professionals.
Collaborative Care Network
Collaborative Care Network
PPACA establishes the community based Collaborative Care Network to support groups of health care providers to coordinate and integrate health care services for low-income uninsured or underinsu...
Demonstration Project: Dual Eligible
Demonstration Project: Dual Eligible
Some elderly and disabled individuals, referred to as dual eligible, qualify for health insurance under Medicare and Medicaid. Previous law authorizes the Secretary to waive selected Medicaid an...
Drug Price Study
Drug Price Study
HHS is required to conduct a study on prices for covered Medicare part D drugs and for covered Medicaid outpatient drugs to determine the financial impact of any such discrepancies on Part D enr...
EHR Incentive: Attestation Begins
EHR Incentive: Attestation Begins
Attestation for the Medicare EHR Incentive Program begins.
Medicaid Emergency Psychiatric Demonstration Project
Medicaid Emergency Psychiatric Demonstration Project
The new law establishes a three-year Medicaid demonstration project for eligible states are required to reimburse certain IMDs that are not publically owned or operated for services provided to ...
Medicare Coverage Expansion
Medicare Coverage Expansion
Expands Medicare coverage to individuals exposed to environmental health hazards.
Medicare Part B Income Threshold Change
Medicare Part B Income Threshold Change
Maintains the 2010 income thresholds for the Medicare Part B program for the period of 2011 through 2019.
Quality Incentive Payments to Physicians
Quality Incentive Payments to Physicians
Providers that are willing to follow new quality measures and report on these measures can obtain an additional incentive payment.

2012

Action Items

Oct 1 Health Plan Identifier
Health Plan Identifier
Effective Date: October 1 2012
The Secretary shall promulgate a final rule to establish a unique health plan identifier (as described in section 1173(b) of the Social Security Act.
ACA: Implementation
ACA: Implementation
The PPACA creates many changes and by this date state Medicaid programs should have completed their planning for implementing the changes and have begun implementing these changes, including cla...
EHR Incentive: Accept MU Attestations
EHR Incentive: Accept MU Attestations
In order to receive incentive payments in the 2nd year and beyond Medicaid providers must be able to certify meaningful use. Thereafter, states must have completed updating their IT systems to a...
HIPAA: NCPDP D.0
HIPAA: NCPDP D.0
On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010 and from current NCPDP 5.1 version to D.0 for pharmacy related transactions....
HIPAA: ICD-10 Codes Level I Compliance
HIPAA: ICD-10 Codes Level I Compliance
By this time state Medicaid agencies should have completed change requests and requirements, developed policy and process changes and completed level I compliance (executed internal individual s...
HIPAA: ICD-10 Codes Level II Compliance
HIPAA: ICD-10 Codes Level II Compliance
States should begin level II compliance external testing. Level II compliance means that a covered entity is end-to-end testing with each of its trading partners.

Informational Items

Jan 1 Pediatric Accountable Care Organization Demonstration Project
Pediatric Accountable Care Organization Demonstration Project
Effective Date: January 1 2012
Health reform law establishes the Pediatric Care Organization demonstration project where participating states are authorized to allow pediatric medical providers who voluntarily meet certain cr...
Amendment of Medicare, Medicaid, and SCHIP Extension Act of 2007
Amendment of Medicare, Medicaid, and SCHIP Extension Act of 2007
Amends the Medicare, Medicaid, and SCHIP Extension Act of 2007, as modified by the American Recovery and Reinvestment Act, to extend for two years: (1) certain payment rules for long-term care h...
Demonstration Project: Evaluate Integrated Care Around Hospitalization
Demonstration Project: Evaluate Integrated Care Around Hospitalization
There is no related provision in prior law. The law establishes a Medication demonstration that will evaluate whether quality can be improved and Medicare payments reduced by making bundle...
DSH allotments for Hawaii
DSH allotments for Hawaii
Revises DSH allotments for Hawaii for the last three quarters of FY2012 and for FY2013 and succeeding fiscal years.
EHR Incentive: 2011 CY Registration Deadline
EHR Incentive: 2011 CY Registration Deadline
Last day for eligible professionals to register and attest to receive an Incentive Payment for calendar year (CY) 2011.
EHR Incentive: EP Reporting Year Ends
EHR Incentive: EP Reporting Year Ends
Reporting year ends for eligible professionals.
Medicaid Nursing Home Reporting Requirements
Medicaid Nursing Home Reporting Requirements
Upon request, nursing Facilities receiving Medicaid funds must provide information on the ownership of the facility and the facilities governing body.
Medicare Claims Data to Evaluate Providers
Medicare Claims Data to Evaluate Providers
Certain entities can obtain Medicare claims data from HHS that was used in the evaluation of providers and suppliers.
Medicare Part D Changes
Medicare Part D Changes
Requires Medicare drug plans to review the medications of at-risk beneficiaries and automatically enroll them in a medication therapy management program.
Review of Medicaid Trends
Review of Medicaid Trends
Requires Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MEDPAC), to review Medicaid trends in spending, utilization, and financial perform...

2013

Action Items

Jan 1 Increased FMAP for Preventive Services
Increased FMAP for Preventive Services
Effective Date: January 1 2013
State Medicaid programs can receive a 1% increase in FMAP for diagnostic, screening, preventive, and rehabilitative services including clinical preventive services, approved vaccines and any med...
Jan 1 Operating Rules: Eligibility and Claim Status
Operating Rules: Eligibility and Claim Status
Effective Date: January 1 2013
The set of operating rules for eligibility for health claim status transactions are effective not later than January 1, 2013, and may allow for the use of a machine readable identification card....
Oct 1 CHIP: Additional FMAP
CHIP: Additional FMAP
Effective Date: October 1 2013
The FMAP for CHIP shall be increased by 23% but not to exceed 100 percent.
Oct 1 HIPAA: ICD-10 Compliance Deadline
HIPAA: ICD-10 Compliance Deadline
Effective Date: October 1 2013
ICD-10 compliance date.
Dec 31 Penalty: Initial Statement Certifying Compliance
Penalty: Initial Statement Certifying Compliance
Effective Date: December 31 2013
Not later than December 31, 2013, a health plan shall file a statement with the Secretary of HHS certifying that the data and information systems for such plan are in compliance with any applica...
ACA: Changes to Eligibility Systems
ACA: Changes to Eligibility Systems
The PPACA creates many changes and by this date state Medicaid programs should be making changes to their eligibility determination systems. State Medicaid programs must change income rules usin...
ACA: Eligibility Modernization
ACA: Eligibility Modernization
State Medicaid agencies should be well on their way to preparing for many of the changes required by January 1, 2014 by the PPACA. Many changes are required related to eligibility determination ...
ACA: Preparing for Health Exchanges
ACA: Preparing for Health Exchanges
The PPACA creates many changes related to the creation of the new health exchanges included in these changes are: Establishing procedures for enrolling individuals who are identified by an excha...
EHR Incentive: Validate MU Attestations
EHR Incentive: Validate MU Attestations
Incentive payments continue to both Medicare and Medicaid Eligible Practitioners. States should have in place a method to validate the certifications of meaningful use of EPs.
HIPAA: ICD-10 Compliance
HIPAA: ICD-10 Compliance
States should begin moving into production, all systems changes for ICD-10 compliance. Also, all new policy and process changes should be implemented.
HIPAA: ICD-10 Compliance - Level II Compliance
HIPAA: ICD-10 Compliance - Level II Compliance
States should completed both level I end to end internal testing and level II external testing.

Informational Items

Jan 1 Financial Incentives to Medicare Beneficiaries
Financial Incentives to Medicare Beneficiaries
Effective Date: January 1 2013
Provides financial incentives to Medicare beneficiaries who obtain services from high quality physicians.
Jan 1 HHS Website on Provider Performance
HHS Website on Provider Performance
Effective Date: January 1 2013
This new website will provide physician performance information and a comparison of providers.
Oct 1 New Requirements for Medicare hospice providers
New Requirements for Medicare hospice providers
Effective Date: October 1 2013
Beginning on October 1, 2013, HHS will impose new requirements on Medicare hospice providers. These new requirements include the need for the hospice provider to have a face-to-face meeting with...
Oct 1 Plan for CHIP Enrollment Bonus Suspension
Plan for CHIP Enrollment Bonus Suspension
Effective Date: October 1 2013
Prohibits enrollment bonus payments to states for children enrolled on or after October 1, 2013

2014

Action Items

Jan 1 CHIP Eligibility: Income
CHIP Eligibility: Income
Effective Date: January 1 2014
Requires states to make any child determined ineligible for Medicaid as a result of the elimination of an income disregard, eligible of CHIP; Beginning January 1, 2014, states will be required t...
Jan 1 CHIP Eligibility: Adjusted Gross Income
CHIP Eligibility: Adjusted Gross Income
Effective Date: January 1 2014
Beginning January 1, 2014 requires states to use modified adjusted gross income and household income to determine eligibility for CHIP or waiver.
Jan 1 Eligibility: Enrollment Prohibition
Eligibility: Enrollment Prohibition
Effective Date: January 1 2014
Law prohibits Medicaid from requiring as a condition of eligibility that an individual apply for enrollment in a qualified employer sponsored coverage.
Jan 1 HBCS: Protection Against Spousal Impoverishment
HBCS: Protection Against Spousal Impoverishment
Effective Date: January 1 2014
States are required to apply spousal impoverishment rules to Medicaid applicants to receive certain HBCS. Also, states are required to apply spousal impoverishment protections when determi...
Jan 1 Medicaid and CHIP Simplification
Medicaid and CHIP Simplification
Effective Date: January 1 2014
For members of all Medicaid eligibility categories, hospitals are permitted to provide Medicaid services during a period of presumptive eligibility.
Jan 1 Medicaid Coverage: FMAP Increase
Medicaid Coverage: FMAP Increase
Effective Date: January 1 2014
Increases in the FMAP to States for the newly eligibles between January1, 2014 and December 31, 2016. The federal government covers 100% of Medicaid costs of newly eligible individual from...
Jan 1 Medicaid Coverage: 133% FPL
Medicaid Coverage: 133% FPL
Effective Date: January 1 2014
Inception of the State Option to expand eligibility to certain non elderly individuals (under 65) with family incomes at or below the 133% of FPL, these newly eligibles will be funded by the fed...
Jan 1 Medicaid Coverage: Benchmark Benefit Packages
Medicaid Coverage: Benchmark Benefit Packages
Effective Date: January 1 2014
Health reform law modifies benchmark benefit packages available under Medicaid. As of January 1, 2014 such packages are required to provide at least, ambulatory patient services, emergency...
Jan 1 Medicaid Eligibility Expansion - Federal Poverty Level
Medicaid Eligibility Expansion - Federal Poverty Level
Effective Date: January 1 2014
During the transitional period between April 1, 2010 and January 1, 2014, States have the option to extend Medicaid coverage to individuals who have income levels that exceed the 133% FPL....
Jan 1 Medicaid Gross Income Changes
Medicaid Gross Income Changes
Effective Date: January 1 2014
Requires States to use a modified gross income to determine eligibility for Medicaid for non-elderly individuals. Individuals exempt from this requirement include; individuals eligible for Medic...
Jan 1 Operating Rules: EFT and Remittance
Operating Rules: EFT and Remittance
Effective Date: January 1 2014
The standard for electronic funds transfer and the set of operating rules for electronic funds transfers and health care payment and remittance advice transactions are effective January 1, 2014 ...
Jan 1 State Exchange and CHIP Application Simplification
State Exchange and CHIP Application Simplification
Effective Date: January 1 2014
States are required to coordinate and simplify CHIP and Exchange enrollment application process via state-run websites.
Jan 1 State Premium Assistance Subsidies
State Premium Assistance Subsidies
Effective Date: January 1 2014
Allows States to offer a premium assistance subsidy for qualified employer sponsored coverage to children under age 19 - to extend such subsidy to all individuals regardless of age.
Apr 1 Penalty for Non-Compliance with Standard Transactions
Penalty for Non-Compliance with Standard Transactions
Effective Date: April 1 2014
Not later than April 1, 2014, and annually thereafter, the HHS Secretary shall assess a penalty fee against a health plan that has failed to meet the requirements with respect to certification a...
Elimination of Exclusion of Coverage of Certain Drugs
Elimination of Exclusion of Coverage of Certain Drugs
Previous Medicaid law excludes coverage of 11 drug classes including smoking cessation products. States had the option to cover certain excluded drugs and received FFP when they cove...
HIPAA: EFT and Remittance
HIPAA: EFT and Remittance
New standards for electronic funds transfers and health care payment and remittance must be in place by January 1, 2014

Informational Items

EHR Incentive: Last Year to Register
EHR Incentive: Last Year to Register
Incentive payments continue to both Medicare and Medicaid Eligible Practitioners. Also, this is the last year to initiate participation in the Medicare EHR Incentive program.
Elimination of Medicare Improvement Fund
Elimination of Medicare Improvement Fund
Eliminates funding in the Medicare Improvement Fund FY2014.
Rescinds Unused Funds for Medicare Improvement Fund
Rescinds Unused Funds for Medicare Improvement Fund
Rescinds any funds for any FY 2014 through 2018 that are unobligated as of the date of the enactment.

2015

Action Items

Dec 31 Eligibility System Enhanced FFP
Eligibility System Enhanced FFP
Effective Date: December 31 2015
The proposed rule codifies enhanced FFP approval to MITA framework by articulating a set of standards and conditions that States must commit to in order to receive enhanced FFP. These stan...
Dec 31 Penalty: Statement Certifying Compliance with Standard Transactions
Penalty: Statement Certifying Compliance with Standard Transactions
Effective Date: December 31 2015
Not later than December 31, 2015, a health plan shall file a statement with the Secretary of HHS certifying that the data and information systems for such plan are in compliance with any applica...
EHR Incentive: Payment Reductions
EHR Incentive: Payment Reductions
Incentive payments continue to both Medicare and Medicaid Eligible Practitioners (EPs). Payment adjustments will be imposed on EPs who are not meaningful EHR users. The Medicare fee schedule amo...

Informational Items

Oct 1 State Balancing Incentive Program
State Balancing Incentive Program
Effective Date: October 1 2015
Medicaid programs can increase their FMAP by creating a State Balancing Incentive Program to increase non-institutional based long term care services.
Reductions in Medicare DSH Payments
Reductions in Medicare DSH Payments
Disproportionate Share Hospital Medicare payments will be reduced by 75% beginning in FY2015. However, PPACA does include a formula for additional payments starting in FY2015 for hospitals servi...

2016

Action Items

Jan 1 HIPAA: Health Claims Attachments
HIPAA: Health Claims Attachments
Effective Date: January 1 2016
The Secretary shall promulgate a final rule to establish a transaction standard and a single set of associated operating rules for health claims attachments.
Jan 1 Operating Rules: Health Claims and other Transactions
Operating Rules: Health Claims and other Transactions
Effective Date: January 1 2016
The set of operating rules for health claims or equivalent encounter information, enrollment and disenrollment in a health plan, health plan premium payments, and referral certification and auth...
EHR Incentive: Last Year for Medicare Pmts
EHR Incentive: Last Year for Medicare Pmts
Incentive payments continue to Medicaid Eligible Practitioners (EPs). Last year to receive a Medicare EHR incentive payment. Last year to initiate participation in the Medicaid EHR incentive pro...

Informational Items

Grants Available to Improve Access to Immunizations
Grants Available to Improve Access to Immunizations
HHS will make grants available to states through their State plan to improve recommended immunizations for adults and children through the use of evidenced and population based interventions for...

2017

Action Items

Jan 1 FMAP Rates for Nebraska
FMAP Rates for Nebraska
Effective Date: January 1 2017
Sets the FMAP rate for the State of Nebraska to 100% starting January 1, 2017.

Informational Items

EHR Incentive: Further Pmt Reductions
EHR Incentive: Further Pmt Reductions
Incentive payments continue to Medicaid Eligible Practitioners (EPs). Payment adjustments will be imposed on EPs who are not meaningful EHR users. The Medicare fee schedule amount for prof...

2018

2019

Action Items

Jan 1 Medicaid Coverage: Former Foster Care Children
Medicaid Coverage: Former Foster Care Children
Effective Date: January 1 2019
Extends Medicaid Eligibility and coverage to former foster care children who are under the age of 26.

Informational Items

EHR Incentive: Assessment of MU for Payment Reductions
EHR Incentive: Assessment of MU for Payment Reductions
Incentive payments continue to Medicaid Eligible Practitioners (EPs). Payment adjustments will be imposed on EPs who are not meaningful EHR users. For 2018 and thereafter, if the Secretary...
EHR Incentive: Ongoing Payments
EHR Incentive: Ongoing Payments
Incentive payments continue to Medicaid Eligible Practitioners (EPs).

2020

Informational Items

EHR Incentive: Ongoing Payments
EHR Incentive: Ongoing Payments
Incentive payments continue to Medicaid Eligible Practitioners (EPs).

2021

Informational Items

EHR Incentive: Ongoing Payments
EHR Incentive: Ongoing Payments
Incentive payments continue to Medicaid Eligible Practitioners (EPs).