Interview With Seema Verma

In late December, PBS broadcast an interview with Centers for Medicare & Medicaid Services administrator Seema Verma.  Kaiser Health News has published a transcript of excerpts from that interview during which Verma discusses Medicaid – including enrollment, eligibility, services, and children – Medicare for all, administration attempts to reduce health care costs, protection for people with pre-existing conditions, and more.  Read those excerpts in the Kaiser Health News article “One-On-One With Trump’s Medicare And Medicaid Chief: Seema Verma.”

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 Medicaid and CHIP Payment and Access Commission kicked off its December meeting with highlights from its forthcoming issue of MACStats: Medicaid and CHIP Data Book, due out December 18, 2019. MACStats brings together statistics on Medicaid and State Children’s Health Insurance Program (CHIP) enrollment and spending, federal matching rates, eligibility levels, and access to care measures, which come from multiple sources.

Later the Commission discussed a proposed rule that the Centers for Medicare & Medicaid Services issued in November, which—among other changes—would increase federal oversight of Medicaid supplemental payments. The final morning session addressed payment error rates in Medicaid, with a briefing on the annual Department of Health and Human Services Agency Financial Report (AFR). Fiscal year 2019 was the first time that the AFR incorporated eligibility errors since the Patient Protection and Affordable Care Act’s Medicaid eligibility and enrollment changes took effect in 2014.

After lunch, MACPAC staff summarized themes from expert roundtables convened in November, one to explore Medicaid policy on high-cost specialty drugs and another on the need for more actionable Section 1115 demonstration evaluations. Then, the Commission turned its attention to Medicaid estate recovery policies. The final session of the day looked at issues associated with reforming the current Medicaid financing structure to better respond to economic downturns.

At Friday’s opening session, the Commission considered policy options to increase participation in Medicare Savings Programs, which provide Medicare cost-sharing assistance to beneficiaries who are dually eligible for Medicaid and Medicare. Afterward, the Commission continued its examination of care integration for dually eligible beneficiaries, this time focusing on policy options to reduce barriers to integrated care. The Commission then switched gears for a briefing on a new MACPAC analysis of Medicaid’s role in financing maternity care. The December meeting concluded with a review of the draft chapter for the Commission’s March report to Congress analyzing disproportionate share hospital (DSH) payments.

Supporting the discussion were the following briefing papers:

  1. MACStats: Medicaid and CHIP Data Book
  2. Review of Proposed Rule on Supplemental Payments and Financing
  3. Review of PERM Findings
  4. Themes from Expert Roundtable on Medicaid Policy on High-Cost Drugs
  5. Improving the Quality and Timeliness of Section 1115 Demonstration Evaluations: Themes from Expert Roundtable
  6. Medicaid Estate Recovery Policies
  7. Policy and Design Issues for a Countercyclical Federal Medicaid Assistance Percentage
  8. Medicare Savings Programs Policy Options
  9. Barriers to Integrated Care for Dually Eligible Beneficiaries
  10. Medicaid’s Role in Financing Maternity Care
  11. Review of Draft Chapter on Statutorily Required Analyses of Disproportionate Share Hospital Payment

Because they serve so many Medicaid and CHIP patients – more than the typical hospital – MACPAC’s deliberations are especially important to private safety-net hospitals.

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  Find its web site here.

President, VP Attempt to Mediate HHS Feud

President Trump and Vice President Pence have stepped into a feud between Health and Human Services Secretary Alex Azar and Centers for Medicare & Medicaid Services administrator Seema Verma.

Azar and Verma have apparently clashed on numerous occasions in recent months, with Verma criticizing at least one Azar proposal during an Oval Office meeting and Azar being overruled by the president on several occasions.  According to Politico, President Trump “…instructed Azar to smooth things over.”

Verma, meanwhile, met with Vice President Pence, with whom she worked when Pence was governor of Indiana.

As head of CMS, Verma oversees the country’s Medicare and Medicaid programs but reports to Secretary Azar.

Learn more about the clash between Azar and Verma and the attempts of the president and vice president to address them in the Politico story “Trump pulled into feud between top health officials.”

Administration Shares Regulatory Priorities for 2020

The Trump administration’s health care regulatory priorities for 2020 have been outlined by the Office of Management and Budget in a newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”

The statement, an annual OMB document, organizes the priorities as follows:

  • Facilitating patient-centered markets
  • Fixing health care financing through protecting private insurance and Medicare
  • Fixing health care financing through reforming the individual market
  • Fixing health care financing through making the ACA and Medicaid fiscally sustainable
  • Bringing value to health care through price and quality transparency
  • Bringing value to health care through patient-centered health IT
  • Bringing value to health care through deregulation, especially for coordinated care
  • Bringing value to health care through tackling the high cost of prescription drugs
  • Bringing value to health care through accelerated drug and device approval and reimbursement
  1. Promoting health and protecting life
  • Addressing impactable health challenges: kidney health
  • Addressing impactable health challenges: combatting the opioid crisis
  • Protecting conscience and life at all stages
  • Reducing the disease and death associated with tobacco use
  1. Promoting independence
  • Returning TANF to promoting work, marriage and family
  • Supporting adoption
  • Empowering Americans to improve their nutrition
  • Promoting flexibility for states, grantees, and regulated entities

Learn more about the regulatory directions the administration intends to take for the rest of its 2020 fiscal year in the newly released “Statement of Regulatory Priorities for Fiscal Year 2020.”  Go here to see the complete list of regulations that the Department of Health and Human Services intends to pursue in FY 2020, including 55 by the Centers for Medicare & Medicaid Services (CMS).

 

Improper Medicaid, CHIP Payments on the Rise

The rate at which Medicaid and the Children’s Health Insurance Program made improper payments rose considerably in federal fiscal year 2019.

According to the Centers for Medicare & Medicaid Services, the Medicaid improper payment rate in FY 2019 was 14.9 percent, amounting to $57.36 billion in improper payments.  The improper payment rate that year for CHIP services was 15.83 percent, representing $2.74 billion in improper payments.  Both are significant increases over FY 2018, when the Medicaid improper payment rate was 9.7 percent, representing $36.25 billion, and the CHIP rate was 8.57 percent, for $1.39 billion.

CMS maintains that the improper Medicaid payment rate will decline in future years because it has introduced more rigorous enforcement of Affordable Care Act requirements to determine and periodically redetermine eligibility for Medicaid participants.  Because each state is reviewed for improper payments only every three years, the agency maintains, it will take time before the full impact of the more rigorous review of beneficiary eligibility will be seen in annual statistics

Learn more about improper Medicaid and CHIP payments in the CMS fact sheet “2019 Estimated Improper Payment Rates for Centers for Medicare & Medicaid Services (CMS) Programs.”

 

Medicaid Block Grants Hit Bump in Road

The drive toward encouraging states to implement Medicaid block grants hit a bump in the road last week when the formal guidance for states that Centers for Medicare & Medicaid Services administrator Seema Verma suggested was imminent apparently became not-so imminent.

At the time Verma spoke, draft guidance from CMS to the states was under review by the federal Office of Management and Budget.  Last week, however, CMS withdrew that draft, which also was to address state Medicaid per capita cap programs.

The bump in the road does not, however, appear to be more than a temporary detour.  While CMS has not explained why the draft was withdrawn, Verma indicated that the agency still intends to provide guidance to state on Medicaid block grants and per capita spending limits.

NASH has long had concerns about Medicaid block grants, writing in its 2019 advocacy agenda that

Block grants, whether based on individual states’ Medicaid enrollment or on their past Medicaid spending, could impose unreasonable limits on Medicaid spending that could potentially leave private safety-net hospitals unreimbursed for care they provide to legitimately eligible individuals. NASH will work to ensure that any new approach that involves Medicaid block grant continues to give states the ability to pay safety-net hospitals adequately for the essential services they provide to the low-income residents of the communities in which those hospitals are located.

Learn more from the McKnight’s Long-Term Care News article “CMS withdraws proposed guidance on Medicaid block grants, funding caps.”

MACPAC Posts Meeting Transcript

The Medicaid and CHIP Payment and Access Commission met in Washington, D.C. earlier this month.  The issues on MACPAC’s agenda were:

  • state readiness to report mandatory core set measures
  • analysis of buprenorphine prescribing patterns among advanced practitioners in Medicaid
  • Medicaid’s statistical information system (T-MSIS)
  • Medicaid disproportionate share hospital payment (Medicaid DSH) allotments
  • Medicaid policies related to third-party liability
  • Medicaid and maternal health

A transcript of the MACPAC meeting is now available.  Find it here.

Feds Open Door for Exemptions from Medicaid IMD Exclusion

New federal guidelines will make it easier for state Medicaid programs to cover mental health services provided in institutions for mental diseases (IMD).

For years, Medicaid regulations greatly limited the ability of states to pay for care – generally, care related to substance abuse disorder treatment – provided in IMDs; this was generally known as the IMD exclusion.  The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, also known as the SUPPORT for Patients and Communities Act, which was passed in 2018, opened the door for more exceptions to these limits, and last week, the Centers for Medicare & Medicaid Services approved a section 1115 waiver application submitted by the Washington, D.C. Medicaid program to circumvent the IMD exclusion for specific purposes.

At the same time that CMS approved the Washington waiver application it also issued formal guidance to state Medicaid programs outlining the circumstances and conditions under which it would consider waiver applications for similar circumvention of the IMD exclusion to facilitate the provision of care in IMDs for patients with substance abuse disorders and other serious mental health problems.  The CMS guidance memo addresses the types of care for which it might approve a waiver, the types of facilities in which waiver-authorized services can be provided, and the extent to which states could receive federal Medicaid matching funds for services provided to eligible patients through approved programs.

Learn more about the Washington waiver in the Fierce Healthcare article “CMS approves D.C. Medicaid waiver, paving way for broader mental health coverage” and read the CMS guidance memo to states here.

Verma Addresses Medicaid Issues

Yesterday, Centers for Medicare & Medicaid Services administrator Seema Verma spoke at a conference of the National Association of Medicaid Directors.

In addition to discussing a proposed regulation posted earlier in the day that would introduce changes in the regulation of state financing of their Medicaid programs, Verma also addressed:

  • Medicaid demonstration programs
  • Medicaid work requirements
  • a shift toward value-based payments
  • better coordination of care for the dually eligible (individuals serve by both Medicaid and Medicare)
  • enrollment issues
  • improvements in the efficiency of the federal Medicaid bureaucracy

Because private safety-net hospitals care for so many more Medicaid patients than the typical hospital, these issues are especially important to them.

Read Verma’s complete remarks here.

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 Commission devoted its Thursday morning discussion to integration of care for beneficiaries who are dually eligible for Medicaid and Medicare. Panelists Amber Christ, directing attorney at Justice in Aging; Griffin Myers, chief medical officer at Oak Street Health; and Michael Monson, senior vice president for Medicaid and complex care at Centene, presented beneficiary, provider, and health plan perspectives and a question and answer session followed.

After lunch, MACPAC staff briefed the Commission on challenges states face as they prepare for mandatory reporting of quality measures for children enrolled in Medicaid and the State Children’s Health Insurance Program (CHIP) and behavioral health measures for adults enrolled in Medicaid. Immediately following that session, the Commission reviewed a new MACPAC-commissioned study on the effects of federal legislation that provided new buprenorphine prescribing authority for nurse practitioners and physician assistants.

After a brief break, MACPAC staff updated the Commission on the status of the Transformed Medicaid Statistical Information System (T-MSIS). The final Thursday session discussed disproportionate share hospital (DSH) allotments as required in MACPAC’s annual March reports to Congress.

MACPAC’s Friday agenda opened with a session on improving Medicaid policies related to third-party liability: specifically, coordination of benefits with TRICARE, the health coverage program for active duty military and their dependents. There are close to 1 million Medicaid beneficiaries with TRICARE coverage but Medicaid’s ability to collect from TRICARE is limited. The final session of the October meeting addressed Medicaid and maternal health.

Supporting the discussion were the following briefing papers:

  1. State Readiness to Report Mandatory Core Set Measures
  2. Analysis of Buprenorphine Prescribing Patterns among Advanced Practitioners in Medicaid
  3. Update on Transformed Medicaid Statistical Information System (T-MSIS)
  4. Required Analyses of Disproportionate Share Hospital (DSH) Allotments
  5. Improving Medicaid Policies Related to Third-Party Liability
  6. Medicaid and Maternal Health: Work Plan and Further Discussion

MACPAC is a non-partisan legislative branch agency that provides policy and data analysis and makes recommendations to Congress, the Secretary of the U.S. Department  of Health and Human Services, and the states on a wide variety of issues affecting Medicaid and the State Children’s Health Insurance Program.  MACPAC’s deliberations are especially important to private safety-net hospitals because those hospitals care for especially large numbers of Medicaid patients.  Find MACPAC’s web site here.