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Coronavirus Update: March 31, 2020

Coronavirus Update: March 31, 2020

Yesterday the federal Centers for Medicare & Medicaid Services (CMS) published a major update of Medicare and Medicaid regulations that included blanket waivers of a large number of Medicare and Medicaid regulations and requirements.  The following is a summary of the major aspects of this new regulation.

New Policies and Waivers From Medicare and Medicaid Regulations and Requirements

CMS has introduced dozens of changes that involve waivers from current regulations and requirements.  A comprehensive, 26-page CMS document describing these changes can be found here and below are the highlights organized into four broad categories:

  • increasing hospital capacity (what CMS calls “hospitals without walls”)
  • expanding the health care workforce
  • increasing the use of telehealth in Medicare
  • reducing paperwork


Increasing Hospital Capacity

  • CMS is waiving the enforcement of section 1867(a) of EMTALA to permit hospitals to screen patients at off-site locations to help prevent the spread of COVID-19.
  • CMS is waiving certain requirements under the Medicare conditions of participation allow for flexibilities during hospital and psychiatric hospital surges, permitting non-hospital buildings/space to be used for patient care and quarantine sites.
  • For the duration of the public health emergency, CMS is waiving certain requirements under the

CMS Posts COVID-19 FAQ for State Medicaid and CHIP Agencies

State Medicaid agencies and CHIP programs have received new guidance on the federal resources available to them to fight the COVID-19 national health emergency through a new FAQ published by the Centers for Medicare & Medicaid Services last week.

Among the issues addressed in the FAQ are eligibility, enrollment, benefits, cost sharing, workforce issues, telehealth, and more.  Health care providers may find this information useful when serving their patients.

See CMS’s news release describing the FAQ here and the FAQ itself here.…

Block Grants Could Hurt Medicaid, Study Finds

A switch to block grants to fund state Medicaid programs “…would require states to cut coverage, reduce benefits, increase cost-sharing, lower provider payment rates, or otherwise reduce Medicaid expenditures as compared to current law spending levels” according to a new Commonwealth Fund study.

The study, conducted in the wake of the Trump administration’s new guidance on how states can transform their Medicaid programs into block grants and its encouragement that they do so, suggests that such efforts could result in considerable harm to Medicaid beneficiaries, providers of Medicaid-covered services, and state government finances.  Meanwhile, the federal government’s share of state Medicaid spending would likely decline as states reduce their Medicaid spending.  If block grants were to be adopted nation-wide – something that is highly unlikely – federal spending would fall more than $110 billion a year while state Medicaid spending would dip between 6.5 percent and 14.1 percent a year.

States that move to block grants would gain new flexibility to reduce benefits, charge co-pays and premiums, eliminate retroactive eligibility, impose work requirements, introduce closed drug formularies, change managed care network adequacy standards, spend unused federal money for non-health care purposes, and more.

Learn more about the various implications of …


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 February 2020 MACPAC meeting opened with a continuation of MACPAC’s examination of Medicaid’s role in maternal health, when Medicaid officials from Michigan, New Jersey, and North Carolina joined the Commission to discuss how their states are addressing maternal morbidity and mortality.* The Commission plans to include a chapter on maternal health in its June 2020 report to Congress. Commissioners later turned their attention to policy options for improving enrollment in the Medicare Savings Program.

The Commission later took a deep dive into value-based payment in Medicaid managed care. This three-part session began with findings from a series of interviews with state officials, managed care organizations, and other stakeholders aimed at understanding how states use managed care to promote payment reform, conducted by MACPAC contractor Bailit Health. Then, representatives from three of these organizations shared their reactions to the findings and talked about how value-based payment models are working in practice.* The session concluded with Commissioners’ perspectives on the study’s findings and the panelists’ reactions to them, and possible next steps.


MFAR Backlash Continues

Diverse health care and government interests are rallying around their opposition to the proposed Medicaid fiscal accountability rule.

The regulation, proposed by the Centers for Medicare & Medicaid Services in November, would impose new limits on the ability of states to finance their share of their Medicaid spending, potentially jeopardizing provider payments and the ability of high-volume Medicaid providers to operate without suffering great losses.

In all, CMS received more than 4200 written comments in response to the proposed regulation, most of them expressing opposition.  Among those doing so were state governments, the National Governors Association, hospitals and hospital associations, nursing home operators, and health advocacy organizations.  Also among them were DeBrunner & Associates clients the National Alliance of Safety-Net Hospitals, the Safety-Net Association of Pennsylvania, Private Essential Access Community Hospitals (PEACH), the Coalition of Long-Term Acute-Care Hospitals, the University of Pennsylvania Health System, Post Acute Medical, and others.  Also questioning the proposed changes was the National Association of Medicaid Directors, whose executive director questioned the constitutionality of the proposal.

Learn more about the Medicaid fiscal accountability rule, what it seeks to do, and why so many oppose in the Stateline article “Medical Groups Slam Trump Medicaid