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Warning Text’?’ џ Warning Text џџџ%ŽXŽTableStyleMedium9PivotStyleLight16’т8џџџнЗдќѓђ„Ћъdq:FЅ€€РРР€€€cЊўн-2џѕŒNтWgџўЇF†SWЂНcЊўн-2џѕŒNтWgџўЇF†SWЂНЬџЬџџЬџЬџџ™™Ьџџ™ЬЬ™џџЬ™3fџ3ЬЬ™ЬџЬџ™џfff™–––3f3™f333™3™3f33™333\џџџ`…БœSheet1…МSheet2ššЃЃŒЎ  ;  ;џССыќ nX—Effective March 23, 2010, the Secretary shall implement a transition process for ceasing operation of the Healthcare Integrity and Protection Databank 7ш Section 6403: Creates a national health care fraud and abuse data collection program for reporting adverse actions. Eliminates duplication between Healthcare Integrity and Protection Data Bank and the National Practitioner Databank  7@Applies to contract years beginning on or after January 1, 2011. 7SEffective March 23, 2010 and applies to overpayments discovered on after that date. 7The NCCI standard will go into effect for claims filed on or after October 1, 2010. By September 1, 2010, the Secretary must identify Initiative methodologies, which of those should be incorporated, and notify States of the information as well as how to incorporate new methodologies. 76Molina submitted a comment letter on November 16, 2010 76Molina submitted a comment letter on November 16, 2010 7P Section 3013: Provides for state grants to promote health information technology  7 After 10/1/10 7;Health Insurance Portability and Accountability Act (HIPAA) 7 Molina Action 7KHealth Information Technology for Economic and Clinical Health Act (HITECH) 7> Section 3001: Establishes the Office of the National Coordinator for Health Information Technology (ONCHIT) ONCHIT must determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health IT recommended by the HIT Standards Committee.  7YNot later than 45 days after the HIT Standards Committee delivers recommendations to ONC. 7™ Section 3002: Establishes a HIT Policy Committee to make recommendations to ONCHIT regarding the implementation of a nationwide health IT infrastructure.  7+Committee members appointed in April 2009.  7У Section 3003: Requires the HIT Standards Committee to make recommendations to ONCHIT regarding implementation specifications and certification criteria for the electronic exchange and use of HIT.  7с - Adopt operating rules for eligibility and claim status transactions by 7/1/11. - Adopt operating rules for electronic payment and remittance advice by 7/1/12. - Adopt operating rules for claims, enrollment, premium payments and referral transactions by 7/1/14. - Adopt standards for electronic funds transfers by 1/1/14. - Adopt standards and associated operating rules for claims attachments by 1/1/14. - Establishes a unique health plan identifier by 10/1/12.  7ICD-10 Transition  7 By 5/18/09 7<Section 1311: Creates state-based Health Insurance Exchanges 6Molina submitted a comment letter on October 23, 2009. 72Patient Protection and Affordable Care Act (PPACA) 7 Provision 7Effective Date 7Fed/State Action 7Version 5010 Transition  7Ч Section 4101, 4201, 4102: Establishes Medicare/Medicaid incentive payments for meaningful use of EHR technology. Imposes penalties on physicians lacking certified HIT systems by the required dates.   7 2011-2016 7&60 days after enactment (May 23, 2010) 7(HHS published a final rule on May 5, 2010. (45 CFR Part 159) Although the act required the agency to develop a  standardized format , PPACA did not require that this format be established through rulemaking. The rule took effect on May 10, 2010, and the website became active on July 1, 2010.  7ю Section 1104: Requires the Secretary to adopt various Administrative Simplification Requirements. The Secretary will adopt a single set of operating rules for each HIT transaction with the goal of creating as much uniformity as possible.  7&Section 6504: Requirement to Report Expanded Set of Data Elements Under MMIS to Detect Fraud and Abuse. Requires states and Medicaid managed care entities to submit data elements from MMIS as determined necessary by the Secretary for program integrity, program oversight, and administration.  3Molina submitted comment letter on October 21, 2008Section 6508: General effective date. Requires States to implement fraud, waste, and abuse programs before January 1, 2011. ~ AgencyONCONC/OCRCMS HHS/NCVHSHHSHHS/ONC8Children's Health Insurance Program Reauthorization Act ‡Section 601: Requires CMS to release a new Payment Error Rate Measurement (PERM) rule defining criteria for errors and appeals process. GFinal rule released August 11, 2010 (42 CFR Parts 431, 447, and 457). eCMS issued guidance in a State Health Official letter on February 10, 2010. (SHO #10-003; CHIPRA #14)ЌSection 211: Permits States to verify citizenship for newly enrolled individuals in CHIP and Medicaid using a data file match with the Social Security Administration (SSA). eCMS issued guidance in a State Health Official letter on December 28, 2009. (SHO #09-016; CHIPRA #11) Section 203: Permits States to rely on findings from an  Express Lane agency to determine whether a child is eligible for Medicaid or CHIP. ŽSection 6506: Overpayments Extends the 60 days that states have to repay the federal share of a Medicaid overpayment to one year or 30 days after an amount is determined through the judicial processes. Requires the Secretary to issue regulations for states to use in adapting MMIS edits, conducting audits, or other appropriate actions to identify and correct recurring or ongoing overpayments. ZCMS issued guidance in a State Medicaid Director letter on July 13, 2010. (SMD #: 10-014)aSection 3012: Establishes the Health Information Technology Extension Program (Extension Program) 9Section 1103: Requires the Secretary to establish a web portal to identify affordable coverage options. Must allow consumers to receive information on Medicaid, Medicare, CHIP, high risk pool and small group coverage. Also requires the Secretary to develop a standard format to be used in presenting information. BIn September 2010, CMS published the Voluntary Self-Referral Disclosure Protocol (SRDP) on its website to enable providers and suppliers to disclose actual or potential violations of the physician self-referral statute. CMS issued a State Medicaid Director letter in October 2010 that offered initial guidance on the implementation of the Medicaid RAC requirements and published a Notice of Proposed Rulemaking on November 10, 2010.On Jan 24, 2011, CMS published Medicare, Medicaid, and CHIP Screening and Fraud Prevention Rule (CMS-6028-FC) that puts in place prevention safeguards that will help CMS move be< yond the  pay and chase approach to fighting fraud. CMS published an interim final rule with comment period (CMS-6010-IFC) in the Federal Register on May 5, 2010 that implemented new anti-fraud authorities and provisions.€Effective for new providers March 25, 2011, current providers March 23, 2012 and revalidating enrolled providers March 23, 2010.ЧMolina submitted a comment letter on Electronic Health Record Incentive Program /Meaningful Use Stage 1 on March 12, 2010. Molina submitted a comment letter on MU2 requirements on February 25, 2011.;Section 6401: Places new mandates on providers who participate in the Medicare and Medicaid programs. The new mandates include provider screening, enhanced disclosures on applications, greater oversight of new providers and the establishment of mandatory compliance programs with core elements determined by HHS. fSection 13402: Establishes the security provisions and penalties for breach of unsecure protected HIT. ТSection 1561: Health information technology enrollment standards and protocols. The Secretary and the HIT Policy and Standards Committee will develop standards to facilitate enrollment in Federal and State health programs. These standards will include various electronic methods to match patients against information sources relevant to eligibility. Grants will be made available to develop new systems and adapt existing systems to new standards. Section 6402: Enhanced Medicare and Medicaid Program Integrity Provisions Provisions of this section include: Data Matching, Access to Data, National Provider Identifier, withholding of Federal matching funds to states that fail to report enrollee data, and Civil Monetary Penalties Н Section 6507: Mandatory State Use of National Correct Coding Initiative  Requires states to make MMIS methodologies compatible with the federal National Correct Coding Initiative (NCCI.) 624 member committee chaired by David Blumenthal. On March 23, 2011, ONC updated the Federal Health IT Strategic Plan which was originally released in June 2008. The Federal Health IT Strategic Plan: 2011-2015 ("the Plan") reflects ONC's strategy for coordinating with the public and private sector to realize Congress and the Administration's health IT agenda: improving the quality, efficiency, safety and patient-centeredness of health care. The Plan serves as an important tool for guiding federal efforts and investments in health IT over the next five years. sNumerous funding/grant opportunities have been released. $564 million will be awarded under the State Health Information Exchange Cooperative Agreement Program, disbursed through cooperative agreements and awarded on a rolling basis beginning in February 2010. $386 million was awarded to 40 States and qualified State Designated Entities (SDEs) on February 12, 2010rInterim final rule was effective September 23, 2009 (45 CFR Parts 160 and 164). HHS reviewed the public comment on the interim rule and developed a final rule, which was submitted to the Office of Management and Budget (OMB) for Executive Order 12866 regulatory review on May 14, 2010. At this time, however, HHS is withdrawing the breach notification final rule from OMB review to allow for further consideration, given the Department s experience to date in administering the regulations. Until such time as a new final rule is issued, the Interim Final Rule that became effective on September 23, 2009, remains in effect.ЅCMS released a proposed rule, Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers, on September 23, 2010. On Feb. 2, 2011, CMS published a Final Rule 976 Fed. Reg. 22 2011 to improve the integrity of the Medicare, Medicaid and CHIP programs to reduce fraud, waste and abuse. Sub-regulatory rule guidance on finger-printing implementation to be provided- implementation will occur 60 days following that guidance. This guidance will be on HOW finger-printing will be implemented; not IF it will be implemented.3CMS released a proposed rule, Medicare, Medicaid, and Children's Health Insurance Programs; Additional Screening Requirements, Application Fees, Temporary Enrollment Moratoria, Payment Suspensions and Compliance Plans for Providers and Suppliers, on September 23, 2010. On February 2, 2011, CMS published its final rule implementing this provision. On March 24, 2011, CMS released an informational bulletin for guidance on what constitutes a  good cause for a State to determine not to suspend payments and what constitutes as a credible allegation of fraud.ЧCMS issued guidance in a State Medicaid Director letter on September 1, 2010. (SMD#: 10-017) and a second letter on April 22, 2011 to clarify earlier guidance on the appeals component (SMD#: 11-003)AElectronic Health Record Incentive Program/Meaningful Use Stage 1 Final Rule issued July 28, 2010 (42 CFR Parts 412, 413, 422) Meaningful Use Proposed Stage 2 request for comment released January 2011. The National Coordinator for HIT has expressed support for delaying the start of stage 2 of meaningful use until 2014.пMolina submitted a comment letter on January 7, 2011 on federal funding for Medicaid eligibility determination and enrollment activities. Molina is soliciting feedback on the IFR and is also providing feedback thorugh AHIP.5HHS released "Planning and Establishment of State-Level Exchanges; Request for Comments Regarding Exchange-Related Provisions in Title 1 of the PPACA" on August 3, 2010. CMS issued a State Medicaid Directors letter of guidance around the  maintenance of effort (MOE) provisions that ensures that States coverage for adults under the Medicaid program remains in place pending implementation of coverage changes that become effective in January 2014. On July 15, 2011, HHS issued < a Proposed Rule that will assist states in building Affordable Insurance Exchanges. The first proposed rule offers states guidance and options on how to structure their Exchanges in two key areas: (1) Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange, and (2) Ensuring premium stability for plans and enrollees in the Exchange, especially in the early years as new people come in to Exchanges to shop for health insurance. The second proposed rule addresses standards related to reinsurance, risk corridors, and risk adjustment to assure stability in these newly established markets created by the state Exchanges. qSection 3021: Establishes Center for Medicare and Medicaid Innovation (CMI) within CMS www.innovations.cms.gov bThe HIT Policy and Standards Committees approved initial recommendations on August 19, 2010 and August 30, 2010 respectively. On September 17, 2010, Secretary Kathleen Sebelius adopted these recommendations with slight edits. CMS issued a proposed rule on Medicaid Eligibility Expansion Under the Affordable Care Act of 2010; Proposed Rule (CMS-2349-P).уBFinal rule on standards adopted on July 28, 2010. (75 FR 44590). EMolina submitted a comment letter on March 12, 2010 to 75 FR 44590. чFinal rule on standards adopted on July 28, 2010. (75 FR 44590). CMS issued a proposed rule on Exchange Functions in the Individual Market: Eligibility Determinations; Exchange Standards for Employers; Proposed Rule (CMS-9974-P) and Establishment of Exchanges and Qualified Health Plans; Proposed Rule (CMS-9989-P). The HITSCS is asking for feedback from individuals and organizations experienced in deploying specifications developed for the nationwide health information network (NwHIN) Exchange. The group also wants to learn about first-hand practice and observations of individuals involved in setting up the required infrastructure and operational use of the NwHIN Exchange specifications or technical descriptions of the requirements.BMNumerous funding opportunities have been released through the Extension Program. Description of the program for establishing regional centers to assist providers seeking to adopt and become meaningful users of health information technology was published in the Fed Reg on May 28, 2009. Cooperative agreement awards were made pursuant to an open competition to establish 62 Regional Centers. The first set of 32 Regional Center awards was made in February 2010, the second set of 28 awards was made in April 2010, and the final 2 awards were made in September 2010. On January 25, 2011, modifications were published in the Federal Register (FR Doc. 2011-1447) that would lenthen the timeline in the first budget period from two years to four years, and the cost-sharing requirement would reflect a 90/10 Federal/grantee cost share for all four years. Regional health IT extension centers have signed up more than 100,000 physicians, or one third of all primary care providers in the nation, to help them deploy electronic health records, reaching its goal slightly ahead of its yearend schedule.YшCMS published 64 FR 57758. This rule terminates the Healthcare Integrity and Protection Databank (HIPDB) and transfers all data collected in the HIPDB to the National Practitioner Data Bank (NPDB) established pursuant to the Health Care Quality Improvement Act of 1986. This rule will also provides for the disclosure of information, fee collection, establishment of dispute procedures, and an effective date of no later than one year after enactment or when regulations are published. йFinal Rule released January 16, 2009 (45 CFR Part 162 ) mandating that everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must implement ICD-10 for medical coding on October 1, 2013. Ѕ Final rule released January 16, 2009 (45 CFR Part 162 ) mandating that transaction standards for all electronic health care claims must switch to Version 5010 from Version 4010/4010A by January 1, 2012. CMS has instituted a 90-day grace period for HIPAA 5010. To be clear: The compliance date remains January 1, 2012 but the agency said it will not  initiate enforcement action on that compliance before March 31, 2012.Ь8MMS Regulatory Tracking Document (Last Updated 11/16/11)­Progress reports on the HITPC and HITSC and their workgroups are incorporated into "Policy Briefs" routinely distributed to the team for updates. Latest update sent 11/1/11“)šMolina submitted a comment letter on March 12, 2010 to 75 FR 44590. Molina also submittted a response on October 31, 2011 on CMS-9974-P) and (CMS-9989-P)En/ai CMS released a proposed rule, Federal Funding for Medicaid Eligibility Determination and Enrollment Activities, on November 8, 2010 that requires States to commit to adopt the standards in this section to receive enhanced FFP. On Sept 30, 2010, NCVHS recommended the designation of CAQH as the operating rule development entity for operating rules for non-retail pharmacy-related eligibility and claim status transactions. Further recommendations on potential candidates to develop operating rules for these two transactions will be developed in Spring '11. On Feb. 17, 2011, NCVHS submitted to HHS recommendations on the implementation of the administrative simplification provisions. It is now up to the HHS Secretary to decide whether to accept or reject the Committee s recommendations. June 2011 Interim Final Rule (IFC) proposes adoption of Phase I and Phase II CAQH CORE, except for acknowledgements; highlights CORE Certification is voluntary- urther defines relationship between standards and operating rules, and ROI. On July 8, 2011, CMS issued an Interim Final Rule with Comment adopting operating rules for two electronic transactions: eligibility for a health plan and health care claims status. CAQH CORE submitted a comment letter to CMS to include Acknowledgements to realize ROI, maintain broad scope of operating rules given ACA goals, and name CAQH CORE as single operating rule author given need for industry direction and resources . On September 22, 2011, NCV<*HS issued a letter recommending Acknowledgements are formally recognized standards and that CORE operating rules for these standards also be recognized g…Molina submitted comments on September 27, 2010 Company-wide position paper on HIX design included in the Communication Toolkit. Molina has also created an HIX tracking document to track state level activity in each MCO/MMS state on HIX. Molina also submitted a comment letter on October 31, 2011 on the Establishment of Exchanges and Qualified Health Plans; Proposed Rule (CMS-9989-P)ё)rCMI formally established on November 16, 2010. On March 22, 2011, CMS formally launched its innovations website where it plans to gather and test new ideas and pilot models for coordinated care for patients, as well as shared payments for healthcare providers. The Web site also provides access to a portfolio of criteria that models will need to meet. On March 31, 2011, HHS released a proposed rule defines eligibility requirements of ACOs, the types of providers that may be included in an ACO, how providers can participate in this new model of care, and criteria that will be used to reward ACOs that lower growth in health care costs while meeting delineated performance standards. On 10/20/11 CMS issued the final ACO Regulation that included changes to make the program more flexible than initially proposed and include, among many others, changing the beneficiary assignment process from retrospective to prospective, reducing the number of quality measures providers are required to report, establishing a rolling admissions process, and making the one sided-model completely risk-free for the entire length of the agreement Вp=Molina responded to the ACO proposed regulation in June 2011.8Molina responded to the proposed regulation on 10/31/11.џZZ4 9ЛШ<zц@˜ FЧ1HууJ•ƒW@fЯ‹yїГ‡ccжж––Bх››ŒŒ ЊЭй  ЯЏЛ  dќЉёвMbP?_*+‚€%џСnk&C&"Verdana,Bold"Molina Medicaid Solutions&"Verdana,Regular" &"Verdana,Italic"Health IT Regulatory Trackingƒ„&ш?'ш?(№?)№?M–LANIER LD245 PCL 6(мИџъ odќџќџLetter (8.5" x 11")LANIER LD245 PCL 6LPT1:””žADC@АЄ ЯlwЪі ф d''''doъ dчччччччччччччDefaultЁ"dќџќџр?р?œ&œU} Р} @} `} €} р}    џ€\ ?РC ?@ І @ Є@ ” ^ m  ё | @ ?@ ў @ ў@ -@ ^ ў @uy@0 @Vў @ў @љ@@Ђ@њ@ @џ @Ћ џџ§ fOОffff§ D§ D§ D§ D#§ D ОAAAAA § b ОccccAAAAA § E § B § QH§ R$§ QIО@@@@@ § E§ B§ Q=§ R$§ QPО@@@@@ § E§ F§ QJ§ R$§ QQО@@@@@ § O3§ G§ QK§ R$§ QRО@@@@@ § E§ F§ Q>§ R$§ gRО@@@@@ § O9B§ Q?§ R%§ BО@@@@@ § E§ F§ QC§ R&§ Q7О @@@@@ § `О aaaa@@@@@ § O4§ H§ B§ R(§ gRО @@@@@ § E§ I§ QS§ S'§ QDО @@@@@ § E~ N@žу@§ PE§ R(§ PT§ OF~ G@у@§ QU§ R&§ hV§ O:~ GРу@§ ]G§ R)§ ^W§ O8§ B6§ Q@§ R&§ B§ O;~ GРёт@§ QA§ R&§ B§ E§ H§ _L§ R(F§ O § H§ Q5§ R&Q§ O1§ H§ Q2§ R&F§ O<§ H§ QB§ R&F§ O"~ H@у@B§ R&F§ d*ОeMTM§ V0~ X@От@§ Y-§ Z&U§ W.~ X чт@§ Y/§ [&U§ V+~ X у@§ Y,§ Z&U§ L ОMMTM§ K~ NР’у@§ QM§ R(§ P!§ B~ NрBу@§ QN§ R(§ P!ОJJJJJОJJJJJзDв l Z*ZZZZZVZ*ZZFFFFFBBBB> BBB FF>Ж@PJ‹‹J ™ х" я7ggџџџџDШШ@ ЊЭй "Н  dќЉёвMbP?_*+‚€%џСƒ„&ffffffц?'ffffffц?(ш?)ш?Ё"џ 333333г?333333г?œ&œ<3U>Ж@‹‹ggџџџџD ўџџџ ўџџџ ўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџр…ŸђљOhЋ‘+'Гй0ЬHPh|   Ќ ИФфMelissa Johnson HedgepeBMicrosoft Macintosh Excel@ЯзылсИЫ@LЃШ ИЫ@ќRэhЏЬўџеЭеœ.“—+,љЎ0 PXd lt|„ Œ иф Sheet1Sheet2Sheet1!Print_AreaSheet1!Print_Titles  Worksheets Named Rangesўџ џџџџ РF&Microsoft Office Excel 2003 WorksheetBiff8Excel.Sheet.8є9ВqCompObjџџџџџџџџџџџџ rџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџ