The Affordable Care Act: 
Individuals with Disabilities, Individuals with Chronic Conditions and Individuals Who Are Aging 
Building A Strong Foundation for the Future 
Pulling It All Together 

Suzanne Bosstick, Deputy Director 
Disabled and Elderly Health Programs Group Centers for Medicaid, CHIP & Survey & Certification

Provisions of The Affordable Care Act: Section 2302: Concurrent Care for Children
Children electing hospice care may continue to receive curative treatment. 
Provisions of The Affordable Care Act: Section 2401: Community First Choice Option
• Adds Section 1915(k) to the Social Security Act. 
• Optional State Plan benefit to offer Attendant Care and related supports to individuals, providing opportunities for self-direction. 
• Includes 6% enhanced FMAP 
Provisions of The Affordable Care Act: Section 2402: Removing Barriers to HCBS 
– Removing Barriers to HCBS 
• 2402(a) – Secretary to Develop Rules Related to HCBS 
– Directs the Secretary to promulgate rules on HCBS to ensure that systems have systems in place for HCBS related to allocation of resources, providers, maximum choice and control. 
– CMS is working in a cross-HHS workgroup on this provision. 
• 2402(b) – Improvements to HCBS as a State Plan Option 1915(i) 
– Makes important changes to 1915(i) 
– Allows States to design 1915(i) programs specific to certain groups (allows a disregard of comparability) 
– Removes State ability to limit numbers served or establish waiting lists
Provisions of The Affordable Care Act: Section 2403: Money Follows the Person
• Provides for the extension and expansion of Money Follows the Person through 2016. 
• Extension of the MFP Demonstration Program offers States substantial resources and additional program flexibilities to remove barriers. 
• New States can apply to join program. 

Provisions of The Affordable Care Act: Section 2701: Adult Health Quality Measures
• Development of core set of quality measures for adults eligible for Medicaid. 
• Establishment of a Medicaid Quality Measurement Program 

Provisions of The Affordable Care Act: Section 2703: Health Homes for Individuals with Chronic Conditions
• Adds Section 1945 to the Social Security Act 
• Enables States to offer Health Homes to individuals with certain chronic conditions. 
• Provides opportunity for person-centered system of care 
• Coordinated care to ensure access to a multi-disciplinary array of services to treat the “whole” person 
• For State designed programs that meet the requirements, enhanced FMAP (90%) is available for the coordination services. 

Provisions of The Affordable Care Act: Section 10202: Balancing Incentive Program
• Effective October 1, 2011 
• BIP offers a targeted FMAP increase to States that undertake structural reforms to increase nursing home diversions and access to HCBS. 
• The enhanced matching payments are tied to the percentage of a State’s long-term services and supports that is offered through HCBS. 
• Requires States to implement structural changes including: a no wrong door–single entry point system, conflict-free case management services, and core standardized assessment instruments. 
The Foundation for a Redesigned Service System for Individuals with Chronic Conditions

Person Centered 
The following provisions explicitly or implicitly require a strong person-centered planning approach, including functional assessment tools: 
– Community First Choice Option 
– Removing Barriers to HCBS – both in 1915(i) and Secretarial rulemaking 
– Quality Measurement 
– Health Homes for Individuals with Chronic Conditions 
– Balancing Incentive Program 
– Money Follows the Person 
– Home Health – Face to Face Encounters

Individual Control 
The following provisions allow for or explicitly require self-direction and other attributes maximizing individual control: 
– Community First Choice Option 
– Removing Barriers to HCBS – both in 1915(i) and Secretarial rulemaking 
– Quality Measurement 
– Health Homes for Individuals with Chronic Conditions 
– Balancing Incentive Program 
– Money Follows the Person

Quality 
The following provisions include explicit quality requirements: 
- Community First Choice Option 
- Removing Barriers to HCBS – both in 1915(i) and Secretarial rulemaking 
- Quality Measurement 
- Health Homes for Individuals with Chronic Conditions 
- Balancing Incentive Program 
- Money Follows the Person 
- Provisions related to individuals dually eligible for Medicare and Medicaid

Integration 
The following provisions promote or require improved integration and strong coordination (Medicare/Medicaid; acute/primary/LTC and behavioral; community integration): 
– Community First Choice Option 
– Removing Barriers to HCBS – both in 1915(i) and Secretarial rulemaking 
– Quality Measurement 
– Health Homes for Individuals with Chronic Conditions 
– Balancing Incentive Program 
– Money Follows the Person 
– Provisions related to individuals dually eligible for Medicare and Medicaid Integration

Additional Commonalities 
Opportunities for Enhanced FMAP: 
– Health Homes 
– Balancing Incentives 
– Community First Choice Option

The “Triple Aim” 
Per Capita Cost 
Experience Of Care 
Population 
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