Archive for Centers for Medicare & Medicaid Services

 

GAO: CMS Needs to Do Better Job on Demonstration Evaluations

The federal government needs to do a better job of evaluating Medicaid demonstration programs, according to the U.S. Government Accountability Office.

Demonstration programs, on which the federal government spends more than $300 billion a year, exempt states from selected federal Medicaid requirements and regulations so they can test new approaches to providing and paying for care for their Medicaid population.  As part of waiving these requirements, the Centers for Medicare & Medicaid Services requires the states to perform or commission evaluations of the effectiveness of those new approaches.

According to a new GAO study, however, those reports are not always performed in a timely manner, are sometimes too limited in scope, and their results are not sufficiently publicized so that others may learn lessons from the demonstration.  The GAO recommended that CMS establish written procedures for such matter and CMS agreed with this recommendation.

Learn more about the GAO’s review of Medicaid demonstration program evaluations in the GAO report Medicaid Demonstrations:  Evaluations Yielded Limited Results, Underscoring Need for Changes to Federal Policies and Procedures, which can be found here.…

Administration Slows Movement Toward Medicare Quality Payments

The Trump administration is slowing Medicare’s movement toward making greater use of quality in its payment system.

The Obama administration’s goal of having 50 percent of Medicare payments made through a quality or alternative payment model by the end of 2018 now appears to be out of sight.  Instead, the Centers for Medicare & Medicaid Services has partially canceled two bundled payment programs – one for joint replacement and another for cardiac rehabilitation programs – and announced that before introducing new programs it wants to take a closer look at the successes and failures of the alternative payment model programs that have been implemented in recent years.

The Washington Post’s “The Health 202” feature offers an in-depth look at CMS’s current approach to Medicare quality programs and reimbursement system changes.  See it here.…

Medicaid Changes: More Than Just Work Requirements Coming?

While the green light for state applications to impose work requirements on their Medicaid recipients is receiving all of the attention, the Trump administration has issued guidance that appears to pave the way for other major changes in the Medicaid program as well.

Specifically, the Centers for Medicare & Medicaid Services has issued guidance that will enable states to pursue section 1115 waivers to test different ways of serving Medicaid patients that are otherwise not permitted under federal Medicaid law, including:

  • establishing time limits on how many months or years individuals may be enrolled in Medicaid;
  • locking out for a specified period of time Medicaid recipients who have not gone through annual eligibility redetermination or have failed to pay Medicaid premiums;
  • prohibiting hospitals from making presumptive eligibility determinations when they encounter new, low-income patients who are not enrolled in Medicaid at the time;
  • tightening their eligibility requirements;
  • excluding family planning providers like Planned Parenthood; and
  • establishing closed drug formularies for their Medicaid population.

Learn more about how the foundation has been laid for such changes if states are so inclined to pursue them and the implications of such changes if they are implemented in the article “State Waivers as a …

Administration Lays Groundwork for Medicaid Work Requirements

The Centers for Medicare & Medicaid Services has issued guidelines for states interested in adding a work requirement component to their Medicaid programs.

With nearly a dozen states applying to implement controversial Medicaid work requirements, CMS has issued a guidance letter to state Medicaid directors outlining the criteria it will use when considering such applications.

The new policy does not mandate work requirements in state Medicaid programs; it only presents the parameters CMS will use when considering the applications of states wishing to impose such requirements.

For  more information about the new policy, see the following resources:

  • CMS’s news release announcing the new policy
  • The letter CMS sent to state Medicaid directors explaining the new policy
  • A CMS FAQ on the new policy

 …

A New Use for Section 1115 Medicaid Waivers?

Historically, states have pursued section 1115 Medicaid waivers as a means of expanding Medicaid eligibility.

But the Centers for Medicare & Medicaid Services now appears to be looking at granting 1115 waivers to help states reduce their Medicaid populations.

According to a new report published by the Commonwealth Fund, CMS is encouraging states – both Medicaid expansion and non-expansion states – to launch demonstration programs designed to reduce enrollment in “means-tested public assistance” programs such as Medicaid.  In their efforts to cut spending and reduce Medicaid enrollment, states are expected to seek section 1115 waivers to experiment with means of doing so such as:

  • establishing monthly premiums for Medicaid recipients
  • eliminating retroactive eligibility
  • imposing lifetime limits on how long individuals may participate in Medicaid
  • excluding people with substance abuse problems
  • shifting Medicaid enrollment to a single annual open-enrollment period
  • implementing more frequent eligibility determinations

And just last week CMS signaled states that it was now welcoming waiver applications to impose work requirements on some Medicaid recipients.

In a recent section 1115 waiver application, the state of Kentucky, for example, projects that the combination of establishing premiums for Medicaid participation and locking out those who do not make their payments, eliminating …