Designating a lead for ACA implementation creates a dedicated decision-maker responsible for ensuring efficient resource use, coordinated state action, and making implementation decisions that consider state policy goals and the existing infrastructure.

*Milestone details:

*Full name: Designate a lead person or entity to coordinate the state’s implementation of the Patient Protection and Affordable Care Act (ACA).

Relevance to the ACA:

States have responsibility for assisting people with enrollment in public and private coverage options and with ensuring their access to quality health care services. Although the ACA does not require a lead, having a lead to coordinate implementation will help states fulfill these responsibilities, including the following:

Private insurance provisions:

§1001 - Enacts individual and group market reforms, including: no lifetime or annual limits, no rescissions, extension of dependent coverage, standardized definitions of specified insurance and medical terms, and rights to appeals.

§1003 - Creates a premium rate review process to be developed in conjunction with states and offer grants to states to establish and support the process.

§1201 - Prohibits exclusion based on pre-existing conditions or health status, guarantees coverage availability and renewability and establishes minimum benefit standards.

§1311 – Requires states to establish insurance Exchanges (or defer to a federally run Exchange).

Public insurance provisions:

§2001 – Extends Medicaid eligibility to all persons with income below 133% FPL.

§2101 – Extends the CHIP program through 2019.

Access to care provisions:

§5001 – Introduces the health care workforce provisions intended to improve access to and delivery of health care services for all individuals.

Quality provisions:

§3021 - Allows States to test systems of all-payer payment reform.

§6401, §6501 - Impose enhanced provider and supplier screening and termination requirements for Medicare, Medicaid, and CHIP.