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Section 1115 Demonstration: Arkansas Health Care Independence Program "Private Option" Demonstration

The CMS Idea Factory is the tool by which CMS is gathering public comments on pending Section 1115 demonstrations. Please see the instructions below regarding how you can post a comment regarding a pending Section 1115 demonstration.

Section 1115 demonstrations, which enable states to test coverage and delivery system approaches in Medicaid and CHIP, have a significant and varied impact on Medicaid and CHIP beneficiaries, providers, States, Tribes, and local governments. The Centers for Medicare & Medicaid Services (CMS) values public input during the demonstration application Federal review process and has provided a platform for public submission of comments. Listed below is a description of the process and timelines for the Federal public comment process. For more specifics, please see the State Health Official (SHO) letter or regulation.

Once a State’s 30-day public comment period has ended, the State will submit an application to CMS. Within 15 days of receipt of the application, CMS determines whether the application is complete and will notify the State. If CMS determines that the application is complete, CMS will send the State written notice informing the State of receipt of the complete application, the date on which the Secretary received the application, and the start date of the 30-day Federal public notice period. If CMS determines that the application is not complete, CMS will notify the State of any missing elements in the application.

Each pending demonstration has a 30-day Federal open public comment period for the general public and stakeholders to submit comments. CMS will not act on the demonstration request until 15 days, at a minimum, after the conclusion of the public comment period. CMS will continue to accept comments beyond the 30-day period; however, CMS cannot guarantee that comments received after the 30-day comment period will be considered due to the need for a timely Federal response. Therefore, CMS strongly encourages comments to be submitted within the 30-day Federal comment period.

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Please note that CMS will review all comments, but the number of concurrences will not determine CMS’s policy. This is a moderated forum, and comments will not be posted immediately.

About the Arkansas Health Care Independence Program (“Private Option”) Demonstration

According to information provided by the State, under the Arkansas Health Care Independence Demonstration, the State will use premium assistance to purchase qualified health plans (QHPs) offered in the individual market through the Marketplace for individuals eligible for coverage under Title XIX of the Social Security Act who are either (1) childless adults ages 19 to 65 with incomes at or below 138% of the federal poverty level (FPL) or (2) parents between the ages of 19 and 65 with incomes between 17 and 138% FPL (collectively “Private Option beneficiaries”). The Demonstration will further the objectives of Title XIX by promoting continuity of coverage for individuals, improving access to providers, smoothing the “seams” across the continuum of coverage, and furthering quality improvement and delivery system reform initiatives.

Status: Pending New Demonstration Request, Closed
Public Comment Period: Closed
Pending Documents

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  1. Comments from Arkansas Advocates for Children and Families

    Public Comments to the Centers for Medicare and Medicaid Services regarding Arkansas’s Health Care Independence Program


    Dear Secretary Sebelius,

    Arkansas Advocates for Children and Families is very supportive of the steps Arkansas has taken to cover uninsured adult Arkansans earning less than 138 percent of the federal poverty level through the Health Care Independence Act of 2013, also known as the Private Option. Approval of the state’s 1115 demonstration waiver will help Arkansas move toward improved access to health care coverage for all children and families. We appreciate the opportunity to comment on the proposed waiver.

    We want to underscore…

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      0 comments  ·  Flag idea as inappropriate…  ·  Admin →
    • Comments from National Health Law Program

      Below is an excerpt of the National Health Law Program's comments. Our full comments exceed the space allowed; limited space makes it challenging to fully respond to a proposal which is 60 pages long. Our full comments have been provided to CMS staff and will also be available on our website, at:

      http://www.healthlaw.org/index.php?option=com_content&view=article&id=501:health-reform-nhelp-comments&catid=51

      Comments:

      The National Health Law Program (NHeLP) is a public interest law firm working to advance access to quality health care and protect the legal rights of low-income and underserved people. We appreciate the opportunity to provide comments to Arkansas’ proposed Health Care Independence Program § 1115…

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      • Ensure Program Integrity

        Program integrity refers to the proper management of Medicaid to ensure quality, efficiency, and cost effective use of state and federal. Program integrity initiatives work to prevent and detect waste, fraud, and abuse, to increase program transparency and accountability, and to recover improperly used funds.

        HMS recommends that Arkansas Department of Human Services and the Office of Medicaid Inspector General work with CMS to apply at least the same rigorous program integrity standards to the QHPs as is applied to Medicaid FFS today in order to ensure efficient and proper use of taxpayer funds and access to appropriate care.

        For…

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        • Assess a Premium Assistance Program for Employer Sponsored Coverage (ESI)

          CMS and Arkansas may also consider premium assistance not just for QHPs, but also performing a cost-benefit analysis on providing ESI premium assistance for individuals who have access to coverage through their employer. It is conceivable that placing a Private Option member into ESI may be more cost effective than paying premium assistance to a QHP for that same member.

          Traditionally, premium assistance programs encourage low-income families’ participation in private coverage, prevent crowd-out in publicly funded programs, and achieve cost savings by utilizing employer contributions to offset costs. Premium assistance programs use federal and state Medicaid and/or State Children’s Health…

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          • Maintain Medicaid as the Payer of Last Resort

            By state (§ 20-77-306) and federal law [§1902(a)(25) of the Social Security Act], Medicaid is required to be the payer of last resort; that is, all other available third party resources must be used before the Medicaid program pays for the care of an individual eligible for Medicaid. The identification of other insurance and the recovery of overpayments due to other coverage are known as Third Party Liability (TPL).

            In CMS guidance or FAQs released in March 2013, Medicaid and the Affordable Care Act: Premium Assistance, it states “that under all these arrangements, beneficiaries remain Medicaid beneficiaries and continue to…

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            • Arkansas Chapter, American College of Emergency Physicians

              Ms. Marilyn Tavenner
              Administrator
              Centers for Medicare and Medicaid Services
              Dear Ms. Tavenner:
              On behalf of the Arkansas chapter of the American College of Emergency Physicians and the patients our members serve each day in the state’s emergency departments, I urge CMS to ensure that the state of Arkansas’ Section 1115 waiver application, “Arkansas Health Care Independence Program – (Private Option)- Demonstration,” provides adequate coverage to emergency patients and appropriately defines how the state will determine the non-emergency care contemplated in the application.
              The waiver application includes a hypothesis stating that “private option beneficiaries will have lower non-emergency use of…

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              Section 1115 Demonstration: Arkansas Health Care Independence Program "Private Option" Demonstration

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