The Affordable Care Act Medicaid Incentives for Prevention of Chronic Disease Demonstration Project

Section 4108(a)(1)(A)The Secretary shall award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who - (i) successfully participate in a program described in paragraph (3); and (ii) upon completion of such participation, demonstrate changes in health risk and outcomes, including the adoption and maintenance of healthy behaviors by meeting specific targets (as described in subsection (c)(2)). (a)(1)(B) The purpose of the initiatives under this section is to test approaches that may encourage behavior modification and determine scalable solutions. (a)(3)(A)The Secretary shall award grants to States to carry out initiatives to provide incentives to Medicaid beneficiaries who successfully participate in a comprehensive, evidence-based, widely available, and easily accessible program, proposed by the State and approved by the Secretary, that is designed and uniquely suited to address the needs of Medicaid beneficiaries and has demonstrated success in helping individuals achieve ceasing use of tobacco, controlling their weight, lowering cholesterol, lowering blood pressure, and avoiding onset of diabetes. (a)(3)(B) A program under this section may also address co-morbidities (including depression) that are related to any of the conditions described in subparagraph (A). (a)(3)(C) WAIVER AUTHORITY- The Secretary may waive the requirements of section 1902(a)(1) (relating to statewideness) of the Social Security Act for a State awarded a grant to conduct an initiative under this section and shall ensure that a State makes any program described in subparagraph (A) available and accessible to Medicaid beneficiaries. (a)(4)(D) FLEXIBILITY IN IMPLEMENTATION- A State may enter into arrangements with providers participating in Medicaid, community-based organizations, faith-based organizations, public-private partnerships, Indian tribes, or similar entities or organizations to carry out programs described in subparagraph (A). (d)(2) A State awarded a grant to conduct an initiative under this section shall develop and implement a system to-(1) track Medicaid beneficiary participation in the program and validate changes in health risk and outcomes with clinical data, including the adoption and maintenance of health behaviors by such beneficiaries; (2) to the extent practicable, establish standards and health status targets for Medicaid beneficiaries participating in the program and measure the degree to which such standards and targets are met; (3) evaluate the effectiveness of the program and provide the Secretary with such evaluations; (4) report to the Secretary on processes that have been developed and lessons learned from the program; and (5) report on preventive services as part of reporting on quality measures for Medicaid managed care programs.

Applicants should review the eligibility information of the individual funding opportunity announcement issued under this CFDA program.

Applicants should review the funding opportunity description of the funding opportunity announcement issued under this CFDA program for information on participant eligibility requirements. Sec 4108(e) No Effect on Eligibility For, or Amount of, Medicaid or Other Benefits - Any incentives provided to a Medicaid beneficiary participating in a program described in subsection (a)(3) shall not be taken into account for purposes of determining the beneficiary's eligibility for, or amount of, benefits under the Medicaid program or any program funded in whole or in part with Federal funds.

Applicants should review the individual funding opportunity announcement issued under this CFDA program for any required proof of certifications which must be submitted prior to or simultaneous with submission of an application package.

Funding under this program will be used according to the ACA section 4108 statute. States will be reimbursed for approved expenditures through the grant with 100 percent Federal funds. Approvable expenditures will include direct cash incentives, or alternative forms of inducement such as free goods, transportation support, reduced Medicaid program fees, provision of alternative preventive services not normally reimbursable through Medicaid, or payments to family members, friends or community agencies that provide support and facilitation of a participants preventive program attendance and meeting goals of tobacco cessation, controlling or reducing weight, lowering cholesterol, lowering blood pressure, and avoiding the onset of diabetes or improving the management of the condition. Also reimbursement of 100 percent of approved expenditures for the administrative operation of the MIPCD Program is available through the grant. Examples of eligible reimbursable items are: key personnel; MIPCD travel, training, outreach and marketing; IT infrastructure to accommodate the MIPCD reporting requirements; and completing the satisfaction survey requirements.

Section 4108(f) Funding- Out of any funds in the Treasury not otherwise appropriated, there are appropriated for the 5-year period beginning on January 1, 2011, $100,000,000 to the Secretary to carry out this section. The funds in this section may be obligated within the 5-year period beginning 1/1/2011.

Sec 4108(4) APPLICATION- Following the development of program criteria by the Secretary, a State may submit an application, in such manner and containing such information as the Secretary may require, that shall include a proposal for programs described in paragraph (3)(A) and a plan to make Medicaid beneficiaries and providers participating in Medicaid who reside in the State aware and informed about such programs. The standard application form SF-424 and related forms, as furnished by CMS, must be used for this program. Applicants are encouraged to submit a non-binding Notice of Intent to Apply. Notices of Intent to Apply are not required and a state's submission or failure to submit a notice has no bearing on the scoring of proposals received. Notices of Intent to Apply are due no later than February 3, 2011. Applications are due March 1, 2011. Applicants should review the application and submission information in the funding opportunity announcement for specific instructions to apply for this grant program.

Applicant should refer to the funding opportunity announcement under this CFDA program for specific criteria requirements on proposal selection.

Successful applicants will receive a Notice of Award. Unsuccessful applicants will be notified by letter. Applicants should review the award administration information of the funding opportunity announcement issued under this CFDA program.

Applicants should review the award information of the individual funding opportunity announcement issued under this CFDA program for applicable approval/disapproval time range.

Subject to approval, the grant funding will be renewed annually.