TN 62 (12-10)
SI 01130.640 Incentives for Prevention of Chronic Diseases in Medicaid
Citations: Public Law (P.L.) 111-148
A. Introduction to incentives for prevention of chronic diseases in Medicaid
President Obama signed The Patient Protection and Affordable Care Act (ACA), P.L. 111-148, into law on March 23, 2010. Section 4108 of ACA established a program called “Incentives for Prevention of Chronic Diseases in Medicaid” (IPCDM). IPCDM allows the Department of Health and Human Services (HHS) to award grants to states for State-run programs designed to address the needs of Medicaid beneficiaries. Incentives are provided to Medicaid beneficiaries in the IPCDM program who demonstrate success in one or more of the following:
ceasing the use of tobacco products,
controlling or reducing their weight,
lowering blood pressure,
avoiding the onset of diabetes or if a diabetic, improving the management of the condition, or
addressing co-morbidities, such as depression, associated with these conditions.
States may begin submitting requests for grants to HHS on January 1, 2011. Programs approved by HHS can last up to 5 years, but no less than 3 years.
NOTE: A Medicaid beneficiary is an individual who is eligible for medical assistance under a state plan or waiver under Title XIX of the Social Security Act and currently enrolled in such plan or waiver.
B. Policy for incentives for prevention of chronic diseases in Medicaid
Exclude incentives provided to a Medicaid beneficiary for participating in an IPCDM program from resources for Supplemental Security Income (SSI) purposes.
IMPORTANT: Funds retained from IPCDM payments do not need to be separately identifiable to exclude them.
NOTE: Consult regional instructions for more information on various state incentive programs.
C. Procedure for incentives for prevention of chronic diseases in Medicaid
Field offices should use documents in the individual's possession to verify:
Obtain the individual's statement either signed or recorded on a Report of Contact (DROC) of the type, amount, and date of receipt if the above information is not evident from the documents.
If the funds excluded under these provisions are commingled with non-excluded funds, develop according to the policy in SI 01130.700.
For more information on electronic documentation, see GN 00301.285 through GN 00301.289.
GN 00301.285, Statements and Other Documentation
GN 00301.289, Evidentiary Documentation Considerations
SI 00830.765, Incentives for Prevention of Chronic Diseases in Medicaid
SI 01130.700, Identifying Excluded Funds That Have Been Commingled With Nonexcluded Funds