STRATEGIC PLAN - ASPE - U.S. Department of Health and Human ...

CHAPTER 2: Health careand SCHIP. The Indian Health Care Improvement Actof 1976 (Public Law 94-437), as amended, extendedthe Federal obligation to CMS by authorizing paymentfor Medicare and Medicaid services provided throughIHS facilities. This responsibility includes servicesprovided by tribal governments administering healthprograms under authorities through the IndianSelf-Determination and Education Assistance Act of1975 (Public Law 93-638), as amended. The IndianHealth Care Improvement Act further expanded thisresponsibility by authorizing 100 percent FederalMedical Assistance Percentage to States for paymentsto IHS and tribal facilities for Medicaid services. CMSworks with IHS and the tribes to ensure they follow thePayor of Last Resort rule. According to this rule, IHSpays after Medicare or Medicaid has paid for eligibleservices, whether IHS and tribes provide servicesdirectly or a private source provides them underreferred services.Long-Term CareLong-term care can be required by individuals withdisabilities needing assistance with activities ofdaily living, individuals with frailty and/or dementiaassociated with aging, individuals with advancedchronic conditions, and other individuals at or nearthe end of life. The central vision for an efficient longtermcare system is one that is person centered, i.e.,organized around the needs of the individual ratherthan around the settings where care is delivered. Theevolving long-term care system of the future willprovide coordinated, high-quality care; optimizechoice and independence; be served by an adequateworkforce; be transparent, encouraging personalresponsibility; be financially sustainable; and utilizehealth information technology to improve access andquality of care.In an effort to facilitate this system transformation,CMS, in partnership with the U.S. Congress, providesfunding to States, territories, and tribal entities toexpand choices to persons who need long-term careservices. Real Choice Systems Change grants, MedicaidInfrastructure grants, and Systems Transformationgrants are a few examples of HHS efforts to assist Statesin building the needed infrastructure for expandingchoices.HHS also works closely with States, territories,and tribal entities to achieve more flexibility in theMedicaid program. To that end, the Money Follows thePerson Rebalancing Demonstration project builds on thePresident’s New Freedom initiative. 2The Money Follows the Person RebalancingDemonstration project will help States furtheraddress the institutional bias in coverage inherentin the Medicaid program. Selected States will beawarded additional Federal funds to pay for homeandcommunity-based services for the first year thatindividuals transition from institutional care to acommunity-based setting of their choice.The Long-Term Care Insurance Partnership Program isa federally supported, State-operated initiative thatallows individuals who purchase a qualified long-termcare insurance policy to protect a portion of their assetsthat they would typically need to spend down prior toqualifying for Medicaid coverage. Once individualspurchase a long-term care insurance partnershippolicy and use some or all of their policy benefits, theamount of the policy benefits used will be disregardedfor purposes of calculating eligibility for Medicaid. Thisstipulation means that they are able to keep their assetsup to the amount of the policy benefits they purchasedand used. For example, in a State that choosesto participate in the partnership program, onceindividuals have used part or all of their maximumlifetime benefit under their long-term care insurancecoverage, their assets would be protected up to theamount used, up to that maximum lifetime benefit.Individuals would not need to spend those assetsbefore qualifying for that State’s Medicaid program.The Aging and Disability Resource Center grant program,a cooperative effort between CMS and AoA, assists Stateswith their efforts to streamline access to long-term care.Program funding supports the development of “one-stop2 The New Freedom initiative eliminates the barriers that preventpeople with disabilities from participating fully in community life. Itprovides a comprehensive, Governmentwide framework for achievingthat goal.HHS Strategic Plan FY 2007-201231