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  • Final Rule Establishes Matching Rates for Medicaid Beneficiaries

    The Centers for Medicare and Medicaid Services (CMS) issued a final rule Friday implementing provisions of the Affordable Care Act (ACA) on increased Federal Medical Assistance Percentage (FMAP), or matching, rates for certain Medicaid beneficiaries in states. This rule codifies the increased FMAP rates that will be applicable beginning January 1, 2014. 

    An increased FMAP rate is available for medical services provided to people defined as "newly eligible" who are enrolled in the new eligibility group for adults up to 133% of the poverty level. In general, individuals are "newly eligible" if they are enrolled in the new adult group and would not have been eligible for full benefits, benchmark benefits, or benchmark-equivalent benefits under the eligibility rules in that state in effect in December 2009. The newly eligible FMAP is 100% in calendar years 2014-2016, 95% in calendar year 2017, 94% in calendar year 2018, 93% in calendar year 2019, and 90% in calendar years 2020 and beyond. 

    CMS also establishes an increased FMAP for expenditures for nonpregnant, childless individuals in the new adult eligibility group in a defined "expansion state." The expansion state FMAP is the regular FMAP rate increased by the number of percentage points equal to a "transition percentage" (that ranges from 50%-100%) of the gap between the regular Medicaid FMAP and the increased "newly eligible" FMAP. In 2019 and beyond, the expansion state FMAP will be equal to the newly eligible FMAP, which means it will be 93% in 2019 and 90% in 2020 and thereafter.

    The final rule also describes the threshold methodology that states will use to claim the new FMAP rates. 

    CMS is seeking comment on selected provisions of this final rule through June 3 so that the agency can determine whether additional clarification would assist states to implement these aspects of the threshold methodology more effectively.

    Older Cancer Survivors Present Unique Challenge to Health Care System

    The growing number of older cancer survivors presents a unique challenge to the health care system because they are more likely to have multiple chronic diseases and tend to experience poorer physical functioning than younger survivors, says an NBC article based on a study published in Cancer Epidemiology, Biomarkers & Prevention.  

    More than 13 million people had survived cancer and were still alive in the United States as of January 1, 2012. Nearly two-thirds of them were considered "cured," having survived 5 years or more. Forty percent had survived 10 years; 15% had lived 20 years past their diagnosis. The study's authors project that the ranks of cancer survivors will grow by nearly a third over the next 10 years.

    "By 2020, two-thirds of cancer survivors are going to be age 65 or older," said Julia Rowland, PhD, the study's lead author and director of the Office of Cancer Survivorship at the National Cancer Institute, a part of the National Institutes of Health (NIH).  

    "Provision of high-quality care for older adult survivors may require adoption of new metrics and strategies," the authors write. "These include the use of geriatric assessments of health and quality of life, the development of geriatric cancer rehabilitation programs, and the development of multidisciplinary teams with expertise in older adults' complex and unique needs. Optimally, these teams will include geriatric specialists in social work, psychology (or neuropsychology), nursing, rehabilitation, and oncology, along with geriatricians."

    Rowland and colleagues say a concerted effort is needed to better describe older cancer survivors, define and refine standards of quality care for them, and develop delivery systems that reflect the multifaceted needs of this diverse and vulnerable population.