By Rebecca Mayo, J.D.
CMS Administrator Seema Verma gave her first major speech on the future of Medicaid and new CMS policies designed to bring major operational reform. Verma’s speech focused on building better relationships between CMS and the individual states to create a partnership in which states have more control over the operation of their own Medicaid programs. She emphasized flexibility, accountability and program integrity as three key aspects of her plans for the future of Medicaid, and took a strong stance on preventing fraud and wasteful spending.
Flexibility. Verma’s vision for the Medicaid program is not a one-size-fits-all program for every state. She believes that each state should have an opportunity to shape the Medicaid program within their state to fit the specific needs of that state. Federal regulations should be reevaluated to make sure that regulations and reporting requirements are not burdening states, taking up time and resources that could be put to use improving their own programs. States should be encouraged to create community engagement activities and programs and to design unique and innovative solutions to improve quality, lower costs and deliver value to beneficiaries. To encourage innovation and speed up the review processes that hold states back from implementing new programs, Verma announced expedited approval processes, fast-track approval processes, efforts to reduce the backlog of waiver applications, 10-year waivers, and cuts to the reporting requirements that can become too burdensome for some programs.
Section 1115 demonstrations. CMS’ new Section 1115 demonstration bulletin outlines the plans to expedite approvals. CMS explains the plan to streamline and simplify the Demonstration Application template, develop a timeline with each state when an application is submitted, and work to clarify the content of the special terms and conditions within the programs. CMS will work towards an expedited approval process and establish a fast track review process for certain proposals. In addition to the changes in the application process, changes will also be made to the way programs are monitored and evaluated. There will be an effort to minimize the reporting burden on states and streamline the reporting requirements.
CMS also issued a bulletin focused on improvements to the State Plan Amendment (SPA) and 1915 waiver processes. CMS has compiled a package of tools to help states complete SPA and section 1915 waiver submissions. CMS staff will also call states within 15 days of each new submission to do an initial review of critical timelines and address incomplete information to expedite the review process. In an effort to reduce the current SPA backlog, CMS will issue a list of SPAs to each state in order to work through the outstanding SPAs in batches, starting with the oldest 75. The MACPro web-based systems for submission, review, and disposition of SPAs will be expanded, and same page reviews will be eliminated as MACPro expands functionality.
Acountability. Verma announced the first ever state-by-state Medicaid and CHIP Scorecard. The scorecard will allow CMS to understand which programs are working well, which are not, and why there are drastic spending disparities among other things. The scorecard will also apply to CMS, allowing the agency to provide transparency to the public and show where Medicaid dollars are being spent, and if programs and initiatives are producing positive results.
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