Archive for Medicaid long-term services and supports

 

Federal Health Policy Update for Wednesday, July 27

The following is the latest health policy news from the federal government as of 2:30 p.m. on Wednesday, July 27.  Some of the language used below is taken directly from government documents.

Final Medicare Payment Regulations for FY 2023

  • CMS has issued its final FY 2023 Medicare inpatient rehabilitation facility (IRF) payment system regulation, finalizing a rate increase of 3.9 percent, which is greater than the 2.8 percent the agency proposed in April.  To learn more about CMS’s final IRF payment rule for FY 2023, see this CMS fact sheet and the final rule itself.
  • CMS also has finalized its Medicare inpatient psychiatric facility prospective payment system final rule for FY 2023, including a 2.5 percent rate increase.  Learn more from this CMS fact sheet and the final rule itself.
  • In addition, CMS has published its FY 2023 hospice payment rate update final rule, finalizing a 3.8 percent rate increase.  Learn more from this CMS fact sheet and from the final rule itself.

White House

The White House COVID-19 response team has briefed the press about the administration’s latest efforts in the response to COVID-19.  Find a transcript of its latest briefing here.

The White House …

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

The March 2022 meeting began with a follow-up discussion on directed payments in managed care. This presentation reviewed a package of five proposed recommendations related to:

improving the transparency of existing directed payment approval documents, rate certifications, and evaluations;

collecting new provider-level data on directed payment spending;

further clarifying directed payment goals and their relationship to network adequacy requirements;

providing guidance for more meaningful, multi-year assessments of directed payments; and

improving the coordination of reviews of directed payments and managed care rate setting.

The Commission is expected to vote on these recommendations at its April 2022 meeting.

The Commission then continued its discussion on how greater adoption of health information technology could facilitate clinical integration for behavioral health. Prior Commission meetings discussed barriers to adopting electronic health records (EHR), including financing and available products that support behavioral health providers. This presentation had two recommendations for the Commission to discuss: (1) creation of voluntary standards for behavioral health-focused EHRs, and (2) Medicaid mechanisms to finance EHR adoption among behavioral health providers. The Commission will vote

MACPAC Meets

The Medicaid and CHIP Payment and Access Commission met for two days last week in Washington, D.C.

The following is MACPAC’s own summary of the sessions.

MACPAC kicked off its January meeting with a review of a draft chapter for the March 2021 report to Congress and recommendations on a mandatory extension of Medicaid coverage for 12 months postpartum. The Commission received extensive public comment on the recommendations. On Friday, the Commission approved three recommendations as drafted related to postpartum coverage. The Commission recommended that Congress should:

  • extend the postpartum coverage period for individuals who were eligible and enrolled in Medicaid while pregnant to a full year of coverage, regardless of changes in income. Services provided to individuals during the extended postpartum coverage period will receive an enhanced 100 percent federal matching rate;
  • extend the postpartum coverage period for individuals who were eligible and enrolled in the State Children’s Health Insurance Program (CHIP) while pregnant (if the state provides such coverage) to a full year of coverage, regardless of changes in income; and
  • require states to provide full Medicaid benefits to individuals enrolled in all pregnancy-related pathways.

Commissioners then turned their attention to Medicaid estate recovery policies that affect beneficiaries

States, Feds Not Adequately Monitoring Medicaid MLTSS

With more states delegating their programs of Medicaid managed long-term services and supports to managed care entities, state Medicaid programs and the federal government are not adequately overseeing the work of those managed care plans.

As a result, they sometimes fail to notice quality and access problems for beneficiaries, according to the U.S. Government Accountability Office.

When states delegate to managed care plans decisions about the amount and types of services that adults and children with physical, cognitive, and mental disabilities will receive, federal guidelines require states to monitor those decisions for appropriateness.  In too many cases, the GAO has concluded, states are not doing this job well.  To address this shortcoming, the GAO recommends that the Centers for Medicare & Medicaid Services develop a national strategy for overseeing MLTSS and “assess the nature and prevalence of MLTSS quality and access problems across the states.”  CMS rejected these recommendations.

Learn more about the challenges inherent in managed care plans administering Medicaid MLTSS in the GAO report Medicaid Long-Term Services and Supports:  Access and Quality Problems in Managed Care Demand Improved Oversight.

CMS Reports on Medicaid Long-Term Care Spending

The Centers for Medicare & Medicaid Services has issued a report on FY 2016 spending for Medicaid-covered long-term services and supports.  The highlights of the $167 billion in state and federal spending include:

 

  • Home and community-based services have accounted for almost all Medicaid long-term services and supports growth in recent years.
  • Home and community-based services spending increased 10 percent in FY 2016, greater than the five percent average annual growth from FY 2011 through 2015.
  • Institutional spending remained close to the FY 2010 amount.
  • Institutional service spending decreased two percent in FY 2016 following an average annual increase of 0.3 percent over the previous five years.
  • Long-term services and supports provided through managed care continued to grow as states expanded their use of managed long-term services and supports delivery systems.
  • Managed long-term services and supports spending amounted to $39 billion in FY 2016, a 24 percent increase from $32 billion in FY 2015.

Learn more about Medicaid spending and trends for long-term care and long-term services and supports in the new CMS report “Improving the Balance: The Evolution of Long Term Services and Supports, FY 1981-2014,” which can be found here.…