Tag: Medicaid Reform

MM Curator summary

 
 

CMS administrator nominee Brooks-Lasure has extensive experience in key Medicaid issues.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

with Alexandra Ellerbeck

Chiquita Brooks-LaSure appears well on her way to becoming the next administrator of the Centers for Medicare and Medicaid Services, possibly before the month is out.

 

If confirmed by the Senate, she’ll be the agency’s first leader with specific expertise in all three of its biggest programs: Medicare, Medicaid and the Affordable Care Act.

“What is interesting about Chiquita’s career is she’s been at the most ground level of policy, helping to craft regulations that are very esoteric and fine-tuned — very technical aspects of Medicare and Medicaid policy,” said Nancy-Ann DeParle, who led CMS under former president Bill Clinton.

Republicans had virtually no criticisms of Brooks-LaSure at a Senate Finance Committee confirmation hearing yesterday.

A few hot-button topics, including Medicaid work requirements and abortion coverage in ACA marketplace plans, were alluded to. But no one questioned whether she was qualified to do the job.

UNITED STATES – April 15: Chiquita Brooks-LaSure testifies before the Senate Finance Committee during her nomination hearing to be administrator of the Centers for Medicare & Medicaid Services in Washington on Thursday, April 15, 2021. (Caroline Brehman/CQ Roll Call via AP Images)

• During the Clinton administration, Brooks-LaSure analyzed Medicare and Medicaid spending at the White House Office of Management and Budget.
• She worked on the House Ways and Means Committee from 2007 to 2010 as Democrats wrote the ACA.
• Then she helped to implement the law, first at the Department of Health and Human Services and then at CMS.

That’s considerably more agency and legislative experience than previous CMS administrators had.

• Seema Verma, who led the agency under former president Donald Trump, had never worked there before, instead spending the bulk of her career as a Medicaid consultant to states.
• Of  former president Barack Obama’s administrators, Marilyn Tavenner was a nurse, hospital executive and then served as Virginia’s health secretary, while Don Berwick was a pediatrician and founder of a nonprofit institute aimed at improving health care.
• George W. Bush’s CMS administrators included Mark McClellan, who had previously led the Food and Drug Administration and worked at the Treasury Department, and Tom Scully, who had worked at the Office of Management and Budget before leading the Federation of American Hospitals.

Those who know Brooks-LaSure emphasize her diplomatic style.

Melanie Nathanson, now a health-care lobbyist, first met Brooks-LaSure on Capitol Hill while working for then-Sen. Bob Graham (D-Fla.). Brooks-LaSure was more eager than most to hear diverse perspectives and find areas for common ground, Nathanson said.

 
 

“I think that is her natural place — to drive to consensus,” Nathanson told me.

DeParle described Brooks-LaSure as a problem-solver who is both collegial but firm when she feels strongly about something.

“It’s an iron fist and a silk glove,” DeParle said. “When she thinks the policy is wrong, she’s not going to hesitate to let you know it.”

During the hearing yesterday, Brooks-LaSure seemed to show that style when GOP senators expressed concerns over the Biden administration’s approach to the Medicaid program.

“I’m deeply concerned by the administration’s approach to Medicaid,” Sen. Mike Crapo (Idaho), the committee’s ranking Republican, said, referring to the new administration’s recent reversal of the Trump administration’s permission for states to impose work requirements.

“I will work to make sure states understand decisions and, as you said, are part of the decision-making,” Brooks-LaSure responded.

Crapo during a Senate Judiciary Committee hearing in 2020. (Demetrius Freeman/The Washington Post)

CMS will be a critical agency as Democrats seek to expand health coverage.

The White House and top congressional Democrats are currently considering which policy pathways to pursue to get coverage to around 29 million Americans who still lack it. 

Lowering the Medicare eligbility age is one possibility; another is making permanent more generous subsidies in the individual marketplaces. In either case, it would be up to CMS to oversee such changes.

The Senate Finance Committee may vote to advance Brooks-LaSure next week.

The panel is also considering the nomination of former Wisconsin health secretary Andrea Palm to serve as deputy HHS secretary.

A spokeswoman for Crapo responded “TBD” when asked whether the senator would vote to confirm Brooks-LaSure. Spokespeople for Sens. Bill Cassidy of Louisiana and Chuck Grassley of Iowa, two influential Republicans heavily involved in health policy, also declined to comment on how their bosses would vote.

 
 

Clipped from: https://www.washingtonpost.com/politics/2021/04/16/health-202-biden-pick-lead-medicare-medicaid-knows-policy-weeds/

MM Curator summary

 
 

The ARPA increases funding for Medicaid COVID, maternity, SUD and HCBS services.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

As we previously reported, President Biden recently signed into law a $1.9 trillion dollar stimulus bill, the American Rescue Plan Act (ARPA). This historic legislative package provides much needed relief to millions of Americans impacted by the COVID-19 pandemic and essential resources to address the ongoing public health emergency. Among other things, the ARPA allocates funds to the Department of Health and Human Services (HHS) for COVID-19 testing, contact tracing, vaccines, supplies, and other related treatment. To alleviate the strain of the COVID-19 pandemic on America’s public health care system, it includes funding for rural health providers, community health centers, and skilled nursing facilities, and makes important modifications to the Medicare and Medicaid programs. This post summarizes the Medicaid provisions contained in the ARPA and their proposed changes to the Medicaid program.

Coverage of COVID-19 Vaccines and Treatment

The new law includes mandatory coverage of COVID-19 treatment, COVID-19 vaccines, and vaccine administration for all Medicaid enrollees. The Families First Coronavirus Response Act (FFCRA) previously stated that COVID-19 vaccines were covered under Medicaid, but excluded certain Medicaid enrollees who receive limited benefit packages. ARPA clarifies that COVID-19 vaccine coverage applies to all enrollees, with the exception of enrollees only eligible for Medicare cost-sharing assistance or COBRA premium assistance. The vaccines, and the cost of vaccine administration, are available without cost-sharing, and the law provides for 100% in federal matching funds from April 1, 2021 through the last day of the first quarter that begins at least one year after the public health emergency ends. The FFCRA had also created a special eligibility group to cover COVID-19 testing and related services for uninsured individuals. ARPA adds coverage of COVID-19 treatment to the benefits offered to enrollees in this testing group as well as other enrollees who receive alternative benefit plans. This coverage includes specialized equipment and treatment as well as preventive therapies (if otherwise included in State Plan Medicaid) for a condition that may seriously complicate COVID-19 treatment for those who have been diagnosed or presumed to have COVID-19. Coverage of treatment for the COVID-19 uninsured group will be provided without cost-sharing at 100% federal matching funding, whereas states offering alternative benefit plans will receive an enhanced federal matching rate varying by eligibility group. Finally, the ARPA clarifies that outpatient drugs and biological products used to provide COVID-19 treatment to Medicaid beneficiaries will be included in the Medicaid Drug Rebate Program, and eliminates the rebate cap manufacturers pay to Medicaid for coverage of FDA-approved drugs.

Financial Assistance to Medicaid Providers and State Programs

The hefty stimulus package also includes monetary relief for health care providers struggling under the heavy financial burden of COVID-19 response efforts. ARPA provides $8.5 billion for provider relief fund payments to rural Medicaid, CHIP, and Medicare providers, $250 million to form state strike teams that will be deployed to nursing facilities to respond to diagnosed or suspected outbreaks of COVID-19, and 100% in federal matching funds for services provided through Urban Indian health care organizations and Native Hawaiian health systems. ARPA also instructs HHS to recalculate states’ annual disproportionate share hospital (DSH) allotments to ensure that states do not pay any more than they would have paid prior to receiving the 6.2% increase in federal matching funds provided under the FFCRA.

Expanding Medicaid Coverage and Benefits

In addition to COVID-19 relief, the ARPA includes monetary incentives and new options to encourage states to expand Medicaid coverage and benefits available under the program. For starters, ARPA offers a temporary 5 percentage point increase in the Federal Medical Assistance Percentage (FMAP) to the fourteen states who have not yet implemented the Affordable Care Act’s Medicaid expansion. The new law also gives state Medicaid programs a new opportunity to extend Medicaid coverage for pregnant and post-partum women for one year after giving birth. It offers an option with an enhanced FMAP rate of 85% for states to provide community-based mobile crisis intervention services to Medicaid enrollees who are experiencing a mental health or substance use disorder crisis outside a hospital or other facility setting. Finally, the ARPA also offers a 10 percentage increase in FMAP for home and community-based services to incentivize state Medicaid programs to “enhance, expand, or strengthen” home and community-based services under the State Medicaid program.

Looking Forward

The ARPA signals President Biden’s commitment to his stated goals of expanding Medicaid coverage and the benefits available under the Program by creating new options for state Medicaid programs. We will continue to track the Biden Administration’s effort to bolster the Medicaid program as President Biden turns his attention to rescinding Medicaid work requirements.

 
 

Clipped from: https://www.lexology.com/library/detail.aspx?g=43165241-c217-4131-aed7-555d867ec66e

MM Curator summary

 
 

Cornyn is holding of Lasure nomination over CMS un-approving the TX DSRIP waiver.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

WASHINGTON — A top Senate Republican is holding up the confirmation of President Biden’s nominee to lead Medicare and Medicaid, he told STAT.

In a brief interview, Sen. John Cornyn (Texas) said he had placed a hold on the confirmation of Chiquita Brooks-LaSure, the pending administrator of the Centers for Medicare and Medicaid Services, using a phrase that refers to a senators’ ability to temporarily block a nomination from advancing to a vote. His opposition, he said, stems from the Biden administration’s recent rejection of Texas’ request to extend its Medicaid waiver, which the Trump administration had previously approved.

“I met with her one day about the 1115 waiver, and said how important it was to my state,” Cornyn told STAT in an interview, referring to the Trump-approved funding agreement, which helped to reimburse the state’s hospitals for care given to uninsured patients. “Then the next day, the Biden administration rescinded it, and it’s completely in bad faith and irresponsible.”

 
 

In practice, Senate Majority Leader Chuck Schumer (D-N.Y.) can decide how long to honor Cornyn’s hold. It’s unlikely he’d allow Cornyn’s objection to derail the confirmation of a key Biden nominee who is otherwise well-liked among Democrats. Schumer’s office did not immediately respond to a request for comment.

Still, Cornyn’s move underscores his anger, and that of many Texas Republicans, over the White House’s decision.

 
 

The Biden administration told Texas officials on April 15 that it was rejecting their $100 billion request to extend most of its existing Medicaid arrangement for the next decade. In rejecting the waiver, the acting CMS administrator ruled that the Trump administration had not gone through the full federal rulemaking process when it approved the request on Jan. 15, less than a week before Biden took office.

An HHS spokesperson said that Texas’ current waiver lasts through September 2022, which gives state officials enough time to go through the full public comment process. CMS will work with Texas on its waiver resubmission, the spokesperson said.

The move, however, is also seen as an attempt to pressure Texas into expanding its Medicaid program to provide health insurance to more low-income residents.

Currently, Texas is one of 12 states that has not accepted federal dollars for an expansion of Medicaid eligibility since the Affordable Care Act’s passage in 2010. Roughly 5 million Texans, or 18.4% of the population, don’t have health insurance, giving it the highest percentage of uninsured residents among the 50 states.

Congress offered holdout states an extra financial incentive to expand Medicaid in its latest Covid-19 relief package, but that offer doesn’t appear to have swayed Texas officials.

Under the existing arrangement, the federal government allows Texas to use Medicaid funds in ways that are typically not permitted, like reimbursing hospitals for care provided to patients without health insurance.

Progressives have cast Texas’ strategy as a poor substitute for using Medicaid expansion to insure low-income residents and investing in primary care, as opposed to stepping in to cover costs for uninsured patients who wind up needing emergency treatment.

Conservatives, however, have lambasted the Biden administration for jeopardizing care for the state’s most vulnerable.

“I’m going to hold her nomination until we can sort something out,” Cornyn said. “This is our basic safety net for healthcare in Texas, and for the administration to pull the rug out from under us like that is just unacceptable.”

Major health industry groups there, including the Texas Medical Association and Texas Hospital Association, have also objected vocally. The hospital lobby said it was “extremely disappointed” by the Biden administration’s decision, and claimed the move undermined the social safety net during a pandemic.

It’s not immediately clear what impact Cornyn’s hold will have. A Democratic spokesman for the Senate Finance Committee said the panel was likely to vote on her nomination this week. Assuming she prevails in committee, Sen. Majority Leader Chuck Schumer (D-N.Y.), could face delays bringing her nomination to a floor vote in light of Cornyn’s objection. Ultimately, though, nominees only need a simple majority of the Senate to vote for confirmation.

 
 

Clipped from: https://www.statnews.com/2021/04/20/republican-holds-up-biden-cms-nominee-medicaid-waiver/

 
 

MM Curator summary

 
 

Multiple states are working to increase payments to children’s hospitals in neighboring states.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Making top-quality care accessible at out-of-state children’s hospitals has long been problematic for families, providers and Medicaid programs.

 
 

Nearly 90% of children’s hospitals serve out-of-state patients, receiving payments from more than six states on average, according to a federal Medicaid commission report. (Photo: Shutterstock)

Three-year-old Elizabeth Zakutansky was born with a rare genetic condition that causes multiple seizures. Her neurologist, a top expert on treating her condition, practices at Lurie Children’s Hospital of Chicago, less than an hour’s drive from the Zakutanskys’ home in Hobart, Indiana. Her parents would like her to get all her care there.

But Lurie wouldn’t continue to treat Elizabeth, because her insurer, Indiana Medicaid, pays out-of-state providers much less than in-state facilities. That’s true for most state Medicaid programs. So the Zakutanskys pay the Lurie neurologist out-of-pocket for consultations, and the doctor gives detailed instructions for Elizabeth’s care to their local pediatrician.

Related: Delayed health care during pandemic taking a toll on many vulnerable children

When Elizabeth suffers uncontrolled seizures, however, she needs quick interventions. Her parents have to pull their two teenagers out of school and the whole family drives 2½ hours to Riley Hospital for Children in Indianapolis, the state’s only specialized pediatric facility. If she has to be admitted, the family sometimes must leave her there to return to their jobs and school.

“It’s terrible to leave your daughter and drive home so far away,” said Laura Zakutansky, Elizabeth’s mother. “You aren’t there to comfort her. One seizure could kill her. How would you feel about that if you weren’t there?”

Making top-quality care accessible at out-of-state children’s hospitals for kids with complex medical needs has long vexed families, providers and Medicaid programs. The choice of an out-of-state hospital can be a matter of convenience for patients and their families, and it may also mean ensuring state-of-the-art care, since only a limited number of hospitals and physicians in the country have the skills and experience to best treat children with certain conditions.

Congress has recognized the problem. Two years ago, it passed a law allowing states to voluntarily establish a “health home” program, potentially making it easier for out-of-state providers to serve as the coordinating caregiver for children with complex conditions. Participating states would receive a temporary boost in federal Medicaid funding to launch the program. But the Centers for Medicare & Medicaid Services said it has no “definitive timeline” for issuing guidance to the states on how to set this up.

State Medicaid officials argue that their states can’t afford to send children to out-of-state facilities that demand higher payment rates. Children’s hospitals say all they want is rates equal to what Medicaid pays in-state providers. Complicating matters is that most states have private Medicaid managed-care plans running their programs, and those plans decide which providers patients can go to and how much to pay them.

But Indiana lawmakers are moving on bills that would boost Medicaid payments to children’s hospitals in bordering states — Illinois, Kentucky, Michigan and Ohio — to near-parity with in-state facilities. Currently, a facility in Chicago might receive reimbursement as low as one-fourth of what an Indiana hospital would get for the same services. Both the House of Representatives and the Senate passed versions of the bill, and they are expected to reconcile the differences shortly and send it to the governor. The projected annual cost to the state is $300,000 to $950,000. To address fears that it may cost more, the bill would have to be reauthorized in two years.

“These families have to schlep down three hours in the snow to Indianapolis, and if they try to reschedule an appointment, they may have to wait another six weeks to get in,” said state Republican Sen. Mike Bohacek, one of the bill’s lead sponsors. He faced that situation with his own daughter, who was born in 2001 with Down syndrome in critical condition. “We can do better.”

Nearly 90% of children’s hospitals serve out-of-state patients, receiving payments from more than six states on average, according to a federal Medicaid commission report last year. Two-thirds of the states pay out-of-state hospitals a lower rate than in-state facilities. Kids with complex medical conditions account for 40% of Medicaid’s spending on pediatric care.

Children’s hospitals say getting approval from Medicaid agencies and managed-care plans to treat out-of-state children and negotiating payment often takes more time than delivering the care. They have to arrange individualized case agreements for each patient.

Dr. John Cunningham, physician in chief at Comer Children’s Hospital in Chicago, said hospital staff members recently removed a brain tumor in a child from northwestern Indiana. But Medicaid refused a payment deal that would have enabled Comer to continue treating the patient, forcing the family to go to Indianapolis for follow-up care.

“The transfer was not because of the care. It was because of an artificial boundary called a state line,” said Cunningham, whose hospital is treating 275 kids from northwestern Indiana and has hired a lobbyist to push the Indiana bill. “That’s a fundamental problem.”

But Medicaid officials say that sending kids to out-of-state facilities can be too costly and that interstate travel may not be best for the family. “When a children’s hospital prides itself on being the top pediatric center for different conditions, it knows people will come and it doesn’t have to negotiate,” said Matt Salo, executive director of the National Association of Medicaid Directors. “It’s ‘take it or leave it.’ That’s not fair.”

Some states and children’s hospitals have been able to work out broader deals. The Illinois Medicaid program, for instance, has arranged to pay St. Louis Children’s Hospital in-state rates for serving children in the East St. Louis, Illinois, area.

In contrast, Children’s Hospital of Philadelphia leaders say their facility often treats children who live just across the Delaware River in New Jersey for much lower rates than New Jersey’s Medicaid program pays the more distant in-state children’s hospital — or without getting paid at all. It offers some services, such as fetal surgery to correct spina bifida, that aren’t available in New Jersey.

“None of the Medicaid [managed-care] plans in New Jersey has ever complained that our rates are too high,” said Ahaviah Glaser, senior director of health policy at Children’s of Philadelphia, which serves 25,000 New Jersey kids a year. “But behind closed doors, they say it’s too expensive to have a [renowned, out-of-state] children’s hospital in their plan’s network, because it attracts sick kids. That’s illegal and immoral.”

New Jersey lawmakers are considering a bill requiring the state’s five Medicaid managed care plans to offer adequate pediatric care networks within set distance limits.

Wardell Sanders, president of the New Jersey Association of Health Plans, warned that unless it adds rate limits, the bill would hike state Medicaid spending by forcing plans to cover even routine pediatric care at top children’s hospitals in Philadelphia and New York.

Other children’s hospitals around the country also complain about Medicaid barriers to treating out-of-state kids. Leaders at the Denver area’s Children’s Hospital Colorado, which serves thousands of patients from six surrounding states, say their doctors must obtain separate liability insurance policies in each state. And each has a different policy on covering families’ travel and lodging.

“Once we’ve started to see a patient, we don’t have a lot of negotiating leverage,” said Annie Lee, Colorado Children’s executive director of Medicaid strategies and community health. “We have rates from states that are all over the board, and we’re unable to consistently cover the costs of care.”

All this can produce hassles and anxiety for parents of very sick children, who already face tremendous stress and costs.

Vinessa Kirkwood, who lives in an Indiana suburb near Chicago, said she’s had to cancel appointments at Riley Children’s in Indianapolis for her 20-month-old son, Donte, because she can’t afford lodging. Also, she shares a car with her partner, who needs it for work, and she juggles Donte’s care with the needs of her four other children.

She wants Donte, who was born with cerebral palsy and severe digestive problems, to receive his regular care at Lurie Children’s, where he had surgery soon after he was born. So she’s closely watching what happens with Sen. Bohacek’s bill.

“I’ve got those Lurie doctors on speed dial,” she said. “I’m hoping to get back to them soon.”

 

 
 

Clipped from: https://www.benefitspro.com/2021/04/05/out-of-state-pediatric-care-vexes-medicaid-programs/?slreturn=20210312125636