Tag: Medicaid Reform

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Public Charge Executive Order Met With Cheers and Jeers

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The new HHS administration has been ordered to review the Public Charge rule designed to reduce welfare spending for immigrants.

 
 

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.

 
 

— But what might happen next is complicated, experts say

 
 

WASHINGTON — President Biden’s executive order asking three federal agencies to review the “public charge” rule drew plaudits from several health policy experts, while others decried the move as a step in the wrong direction.

The public charge rule, part of the Immigration and Nationality Act, was issued in October 2020 by the Department of Homeland Security. It states that immigrants who are applying for a permanent residency “green card” or for citizenship will be negatively affected on their applications if they have used public programs such as the Supplemental Nutrition Assistance Program (SNAP), Medicaid, or Temporary Assistance to Needy Families for more than 12 months in a 3-year period prior to applying.

Several states sued over the rule, claiming it was unfair, and two courts issued injunctions preventing its implementation; both were eventually lifted by the Supreme Court, although the suits themselves remain active in the lower courts.

Biden Signs Executive Order

On Tuesday, President Biden signed an executive order directing the Justice, State, and Homeland Security departments to “review all agency actions related to implementation of the public charge ground of inadmissibility” and consult with other departments, including Health and Human Services, when considering the rule.

According to the order, the review should “consider and evaluate the current effects of these agency actions and the implications of their continued implementation,” identify appropriate actions to take, and recommend ways to “clearly communicate current public charge policies and proposed changes, if any, to reduce fear and confusion among impacted communities.”

“I’m not making new law; I’m eliminating bad policy,” Biden said. President Trump, he continued, “issued executive orders I felt were very counterproductive to our security, counterproductive to who we are as a country, particularly in — in the area of immigration. This is about how America is safer, stronger, more prosperous when we have a fair, orderly, and humane, and legal immigration system.”

Abner Mason, founder and CEO of ConsejoSano, a tech startup specializing in health equity and multicultural patient outreach for Medicaid plans, predicted that Medicaid will see an uptick in enrollment following Biden’s order, and that providers will get more Medicaid patients. Many immigrants seeking permanent residency or citizenship are thought to have avoided signing up for Medicaid, for fear of jeopardizing their applications.

But he noted that states are temporarily barred from screening Medicaid enrollees carefully during the pandemic. Those new enrollees may eventually face a different jeopardy, once states are again allowed to restrict eligibility. States may need to tighten their fiscal belts and their Medicaid rolls could be an inviting target for cuts.

Immigrants and the Fiscal Burden

Robert Rector, senior research fellow for domestic policy at the Heritage Foundation, a right-leaning think tank here, expressed disappointment with Biden’s order. “The general idea of the rule was a good idea,” even though it’s often misrepresented, he said in a phone interview. “The general thrust of that rule — although the bureaucracy made it exorbitantly complicated — is that as a society we want to be bringing in immigrants who aren’t going to be a fiscal burden for the U.S. taxpayer.”

“What people really don’t understand is that the U.S. has a very large government and it gives a lot of benefits and services; the average household gets over $30,000 a year in benefits and services from the government, including Social Security and Medicare and education costs, routine services like highways and sewers, and means-tested welfare” programs like Medicaid, the Children’s Health Insurance Program, and food stamps. “The sum of those expenditures is over $1 trillion a year,” Rector said.

“Libertarians don’t like me because I don’t want to destroy this welfare system — I believe there is purpose to supporting lower-income people and disadvantaged people to try to help them succeed in society,” he added. “But you can’t do that for huge inflows of people from abroad…. If you have a finite number of people that you want to let in, why would you not want to let in educated people who are going to be fiscal contributors?”

There aren’t a lot of numbers on how many people declined to enroll in programs such as Medicaid or food stamps due to the rule, Rector added. “I don’t think it had an operational effect because it wasn’t around very long … and they managed to make it very complicated.”

But what evidence that did appear suggested the rule may have had some effect, according to Shelby Gonzales, director of immigration policy at the Center on Budget and Policy Priorities, a left-leaning think tank here.

“There is a lot of anecdotal evidence that suggests that people have gone without Medicaid and other important supports out of fear that enrolling would harm their loved ones,” she wrote in an email. “The Urban Institute found that 31.5% of adults with low incomes in families that include children and at least one immigrant reported that they, or someone in their family, avoided participating in a benefit program in 2019 because of concerns about how benefit receipt would affect immigration status.”

Gonzales lauded the executive order as “an important first step to address the fears people have,” but added that “a lot more work will need to be done to address the damage of this rule.” Among other actions, “the federal government should launch a comprehensive outreach campaign aimed at addressing the concerns people have and letting them know it’s safe for them to access benefit programs for which they are eligible,” she said.

Rachel Garfield, PhD, co-director of the Program on Medicaid and the Uninsured at the Kaiser Family Foundation here, noted in an email that “in recent years we have seen increases in the uninsured rate among the Hispanic population, which could reflect the effects of the public charge rule. In terms of how the change in administration will change these recent trends, it remains to be seen, but we do know that word of mouth and informal information networks are important source of information among this population, so it will somewhat depend on how messaging about a shift in direction occurs.”

Ripple Effects

Kelly Whitener, JD, associate professor of the practice at the Georgetown University Center on Children and Families, agreed that the rule influenced more people than those directly targeted. “For example, children’s use of Medicaid/CHIP is not counted in a public charge determination if that child were to later apply for a green card, nor is it counted in the parent’s application, and yet, we saw declines in Medicaid/CHIP participation among children in immigrant families,” she said in an email.

While the Biden order “is a very meaningful and important step in the right direction, it will take a long time to undo the damage that has been done over the last 4 years,” Whitener said. “The public charge rule changes made by the Trump administration are still in effect and will remain in effect until new rules replace them, which will take months if not years.”

In the meantime, the rule continues to be tied up in court, explained Sonya Schwartz, JD, a consultant with Protecting Immigrant Families, a campaign composed of several organizations working on immigrant rights issues. A total of 11 lawsuits — including those in which the injunctions were issued — have been brought against the rule, and the Supreme Court may eventually take up one or more. “Yesterday, a district court in Illinois asked for the Department of Justice to come in” and explain its plans in a case there, “and on Feb. 19th, we’ll know a little more about what the department plans to do.”

One possibility is for the department to drop its earlier requests for Supreme Court review of lower court rulings against the Trump administration rule. Or the Supreme Court — which is having its next case conference on that same date, Feb. 19 — could simply decide not to hear them, she said.

Another option is that the Department of Homeland Security could issue an interim final rule on the subject “due to the pandemic and all the fear, and how this rule threatens to undermine our vaccine efforts and making sure people get tested and treated for COVID,” said Schwartz. “So I think there are a lot of options where we could get policy change a little bit faster, either through the courts or the agency acting quickly, but we just don’t know yet.”

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Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

 
 

Clipped from: https://www.medpagetoday.com/publichealthpolicy/medicaid/91058

 
 

 
 

 
 

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Department of Human Services Provides Updates on Work Supports System for Medicaid Recipients

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Pennsylvania continues the rollout of its program to connect Medicaid members who want to work to jobs and skills building programs.

 
 

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.

 
 

Harrisburg, PA – Department of Human Services (DHS) Secretary Teresa Miller today outlined the Medicaid Work Supports system, a program designed to connect people whose health care is covered through Medicaid to local employment and training resources, with a goal of supporting people in finding long-term employment and achieving financial independence. As Pennsylvania continues to experience economic challenges from the COVID-19 pandemic, DHS hopes this program can be a bridge to employment for people affected by job or income loss.

Medicaid provides critical access to health care for people who would not otherwise have access to essential services like preventative visits, screenings, and medications – things we all need to stay healthy and lead an enriched, fulfilling life. Many people on Medicaid are over the age of 65 or have a chronic illness or long-term disability. Medicaid also supports people ages 19-64 with incomes at or below 133 percent of the federal poverty income guidelines. Medicaid connects more than 3.1 million Pennsylvanians to basic and life-saving health care, and enrollment in this program has grown by 300,000 people since February 2020, likely due to the economic insecurity created by COVID-19.

Prior to February 2020, most Medicaid recipients did not have a targeted connection to employment resources and support.

“One of the DHS’ top priorities remains increasing employment opportunities for those we serve. We know that many people who use safety-net programs want to work and reach their potential in jobs that lead to independence,” said Secretary Miller. “We recognized an opportunity to offer more support to people who need it in a meaningful way that meets people where they are. The Medicaid Work Supports program – a proactive, direct referral to employment and training resources – is an opportunity to fix disparities and help all people served by this system take a step forward in life.”

DHS worked with partners across the state – including the Department of Labor & Industry, Physical Health Managed Care Organizations (MCOs), Local Workforce Development Boards, and more – to implement a systematic identification and connection framework to increase workforce participation and long-term employment outcomes.

Now, when someone enrolls in Medicaid for the first time or transfers Medicaid plans, they are asked if they are interested in learning about employment resources. If they respond “yes,” they receive one of the following three outreach strategies depending on their circumstances:

  1. A letter that explains the services available at their local PA CareerLink™ office. PA CareerLink™ provides services including help with searching and applying for a job, providing a list of local job openings, and counseling to explore career interests. Some participants may also be eligible to receive support for new training and education opportunities.
  2. If the individual is a recipient of other benefits such as the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF), the recipient’s County Assistance Office (CAO) will reach out to discuss the person’s interest in a DHS-approved employment and training program. The CAO will help with the referral and supports as needed.
  3. If the person is not in either of the previous groups, they will receive outreach from their selected MCO, which oversees a range of their health care services. Several MCOs have in-house programs ranging from GED support to general employability skills workshops to trainings for positions within their own healthcare systems.

These outreach and referral efforts are tracked by DHS to ensure that Medicaid beneficiaries receive the supports and information they requested.  DHS is also working with the PA Department of Labor & Industry to collect data on the program’s long-term outcomes for individuals who participate, such as time employed and wage gains. DHS will use this information to inform future decisions regarding Medicaid Work Supports programming.

Since the launch of Medicaid Work Supports in late February 2020, more than 38,000 people have indicated an interest in learning more about local employment resources, averaging about 800 people per week. Early reviews indicate that these efforts are creating space to discuss not only employment, but a range of other complex situations individuals experience, all of which contribute to stability and economic independence. In the future, use of the Resource Information and Services EnterpriseOpens In A New Window (RISE) PA tool will further support these efforts to address social determinants of health as part of the whole-person approach.

The Medicaid Work Supports program is not a work requirement, which as a policy functionally jeopardizes individuals’ access to health care and undermines efforts to help people achieve long-term employment. This program was designed to help people, especially communities that experience greater barriers to finding and retaining employment, move out of poverty.

Through person-centered services and a commitment to reform, DHS’s workforce-focused efforts aim to confront the impact of systemic racism and the inequities that racism has created over many decades. About 25 percent of Medicaid beneficiaries are Black despite being 13 percent of Pennsylvania’s general population. Poverty is not a personal or moral failure, but it is often a consequence of systemic racism and limited resources in particular communities or neighborhoods, which can often be tracked back to segregation-era policies. DHS is focused on uprooting systemic racismOpens In A New Window and promoting economic justice, particularly for all communities and individuals who use public assistance programs.

“As we look to recover from the economic crisis created by COVID-19, we hope that this focus on equity and opportunity for all people will allow us to help people who may not have been reached or meaningfully served by similar efforts previously. Economic recovery for all Pennsylvanians helps all of us, and the Medicaid Work Supports program gives us a way to help people in this journey. If there are individuals who have fallen on difficult circumstances because of the crises and collective trauma we are all facing, help is available,” said Secretary Miller.

Applications for Medicaid and other public assistance programs can be submitted online at www.compass.state.pa.usOpens In A New Window. Those who prefer to submit paper documentation can pick up an application at their local CAOOpens In A New Window, where social distancing protocols are in place, or they can print from the website or request an application by phone at 1-800-692-7462.They can then mail it to their local CAO or place it in a CAO’s secure drop box, if available. You do not need to know your own eligibility in order to apply. While CAOs remain closed, work processing applications, determining eligibility, and issuing benefits continues. Clients should use COMPASS or the MyCOMPASS PA mobile app to submit necessary updates to their case files while CAOs are closed.

For more information on DHS’ E&T Programs visit www.dhs.pa.govOpens In A New Window.

MEDIA CONTACT: Erin James – ra-pwdhspressoffice@pa.gov

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Clipped from: https://www.media.pa.gov/pages/DHS_details.aspx?newsid=654

 
 

 
 

 
 

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State leaders react to Medicaid bill funded by medical marijuana

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Kansas Governor Kelly is proposing to fund Medicaid expansion with marijuana taxes.

 
 

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.

 
 

(Dakota News Now)

TOPEKA, Kan. (WIBW) – State leaders are backing Governor Laura Kelly’s Medicaid expansion bill that will be funded by medical marijuana.

Governor Laura Kelly announced legislation on Monday to expand Medicaid and provide health insurance for 165,000 Kansans. She said the legislation would also establish a regulatory framework to make Kansas the 48th state to legalize medical marijuana.

Kansas leaders have been speaking of the announcement ever since. Many think the Medicaid overhaul is much needed and will result in a healthier and more productive workforce.

“Making health care available to thousands of low-income, uninsured Kansans would help working Kansans and their families, resulting in a healthier, more productive workforce and benefit employers across the state,” said Tracey Osborne Oltjen, President and CEO of the Overland Park Chamber of Commerce. “We know that people who have health coverage are generally healthier and more productive at work. From a business perspective, that’s why Medicaid expansion is so important. Until we expand Medicaid in Kansas, we risk falling further behind our neighbors. We should not stand as an island on this issue, creating expensive challenges for our residents and our businesses.”

The Kansas Hospital Association says currently, 38 states have implemented or are moving toward Medicaid expansion. It said all of the states that border Kansas have taken steps to expand Medicaid and it is important that Kansas have a serious discussion about it. It said kanCare expansion will help every community in Kansas.

“The Kansas Hospital Association continues to support KanCare Expansion and the benefits it will bring to Kansas,” said the KHA. “Expansion improves the health of Kansans by improving access to tens of thousands of hardworking Kansans who cannot afford to wait another year for affordable health care coverage. We must have a Kansas-based solution – a solution that brings hundreds of millions of our federal tax dollars back home to Kansas – creating jobs, boosting our economy and improving the health of Kansans.”

According to Kansas Appleseed Center for Law and Justice, the COVID-19 pandemic has further exacerbated the Medicaid issue. It said legislators are allowing Kansans to fall through the cracks and expansion of Medicaid will allow the state to mitigate further inequities in Kansas’ healthcare system.

“Accessible, truly affordable healthcare is critical to achieving a more thriving, inclusive and just Kansas. In each corner of our state, COVID-19 has magnified the invaluable role healthcare plays in keeping our loved ones and our communities safe,” said Kansas Appleseed. “Prior to the co-occurring health and economic crisis brought on by the pandemic, nearly 90,000 Kansas fell within the coverage gap, rendering our state ill-prepared to meet the needs of those who would be impacted. Refusing to expand Medicaid has also had disparate impacts on Black, Indigenous, and communities of color, compounding the already-existing disparities created by institutional and systemic racism and oppression dating back to our country’s founding.”

Lt. Governor David Toland said the state’s economic recovery may even depend on the new bill.

“Our economic recovery depends heavily on our ability to attract and retain businesses throughout the state,” said Toland. “Kansas has no business giving companies even one reason to look elsewhere — and I can say, unequivocally, that the availability of healthcare and well-being of all Kansans matters a great deal to companies considering places to locate and grow.”

Many in the Kansas House of Representatives took to Twitter to show support for the bill.

Gov. Kelly said the bill would designate the Kansas Department of Health and Environment to be responsible for the oversight of patients and their use of medical marijuana, KDOR would be responsible for licensure and fee collections as well as regulation of producers and the Board of Healing Arts would be responsible for certifying prescribing doctors. She said it would also establish a bipartisan medical marijuana advisory committee with appointments made by Gov. Kelly, legislative leadership and chaired by the Secretary of Health and Environment.

Clipped from: https://www.wibw.com/2021/02/02/state-leaders-react-to-medicaid-bill-funded-by-medical-marijuana/

 
 

 
 

 
 

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Judge blocks Texas effort to remove Planned Parenthood from Medicaid

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The Texas effort to block state funds to the abortion chain is working its way through the courts.

 
 

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.

 
 

Clipped from: https://thehill.com/regulation/court-battles/537467-judge-blocks-texass-efforts-to-remove-planned-parenthood-from?rl=1

 
 

A district court judge in Texas moved late Wednesday evening to temporarily halt the state’s effort to remove Planned Parenthood from its Medicaid program just hours before the state was set to do so.

A state district judge in Travis County, Maya Guerra Gamble, granted three Planned Parenthood affiliates operating in Texas a temporary restraining order while setting a hearing for Feb. 17.

“It appears from the specific facts set forth in the verified Application for Temporary Restraining Order, and the evidence submitted to the Court, if any, that immediate and irreparable harm will result to Providers before notice can be served on the OIG and HHSC and a hearing can be held on Providers’ request for a temporary restraining order unless the OIG and HHSC are restrained as requested,” Gamble wrote, referring to the Texas Health and Human Services Commission and its Office of Inspector General.

Texas officials had sent a notice to Planned Parenthood providers in late January stating they would be kicked out of Medicaid, the state-federal health program for the poor. 

The organization is seeking to continue to receive Medicaid funding to provide non-abortion services, and filed an emergency lawsuit asking courts to institute a temporary restraining order Wednesday alleging that Texas failed to issue a “proper termination notice” under state law governing which providers are covered by Medicaid.

“For now, if courts don’t immediately step in to block [Texas Gov. Greg] Abbott’s harmful order, 8,000 Texans with low incomes could lose access to critical, life-saving health care, including cancer screenings, STI testing and treatment, and birth control,” Planned Parenthood said in a decision ahead of the judge’s order. The organization’s Texas affiliates did not immediately return requests for comment Thursday evening.

“Texas’s Medicaid ‘defunding’ offers a clear example of how critical it is for the Biden-Harris administration to stop attacks that target the reproductive health care of people with low incomes, women, and people of color,” the organization continued.

Their efforts could end up setting off a battle with the Biden administration, which signaled Thursday that it would enforce federal Medicaid guidelines governing which organizations receive funding.

“Well the president’s views are clear and consistent on this issue,” White House press secretary Jen Psaki

 
 

Jen PsakiCable news could learn something from Psaki and Cronkite
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MORE said during her daily news briefing. “Just last week in an executive order he reissued guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers. HHS would certainly have more specific details but they have stated they are committed to protecting and strengthening the Medicaid program as is the President consistent with the Executive Order we released last week.”

Updated 10:30 p.m.

 
 

 
 

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The Health 202: Biden narrows picks to lead Medicare and Medicaid down to two choices

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A Manatt consultant and former Bacerra associate is being heralded as the next head of CMS.

 
 

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

The Biden administration has narrowed its search for Centers for Medicare and Medicaid Services administrator to two people – former Obama administration appointee Chiquita Brooks-LaSure and North Carolina Health Secretary Mandy Cohen, five people with connections to the administration tell me. 

 
 

The eventual pick to lead the federal agency that oversees the government’s major health insurance programs will play a central role in reshaping how the government manages safety-net programs that provide tens of millions of Americans with health coverage, after some controversial and unprecedented reconfigurations by the previous administration. CMS is a trillion-dollar agency that oversees Medicare, Medicaid and the Affordable Care Act. 

 
 

Cohen, as chief operating officer and chief of staff, and Brooks-LaSure as deputy director in the office that oversees the ACA’s insurance marketplaces and regulations. Brooks-LaSure is currently a managing director at consulting firm Manatt. In the years immediately after 2010 law was passed, Brooks-LaSure worked as director of coverage policy in the Office of Health Reform at the Department of Health and Human Services.

“They would both be great, and they are both really well-liked,” said a person with close ties to the administration who spoke on the condition of anonymity to discuss the personnel matter.

Brooks-LaSure is now favored for the spot, three of the sources said. 

She was more involved in Biden’s campaign and headed up his HHS transition team. That could put her in a better spot to immediately start working with civil servants within CMS.

“She is very calm and very measured,” said Dan Mendelson, whose firm Avalere Health employed Brooks-LaSure from 2003 to 2007. “She doesn’t react too quickly and I think that kind of thoughtfulness will be really useful given the range of issues they have to deal with right now.”

There’s another potential benefit to picking Brooks-LaSure: she has previously worked alongside California Attorney Xavier Becerra, who is Biden’s nominee for HHS secretary. She served as a staffer on the House Ways and Means Committee while Becerra was a member of that committee.

The well-documented acrimony between former HHS secretary Alex Azar and former CMS administrator Seema Verma under the Trump administration serves as a recent warning of the dysfunction that can occur when these two influential appointees don’t work harmoniously.

The White House declined to comment on the status of the CMS nomination. Neither Brooks-LaSure nor Cohen responded to emailed questions.

The next CMS director will have a lot on their plate.

Top on the agenda will be unraveling changes the Trump administration made to the Obamacare marketplaces and the Medicaid program. 

As we’ve reported, the new administration is likely to crack down on short-term plans that can offer skimpy benefits and tighten up rules around the insurance products that are sold on HealthCare.gov and the state-run exchanges. Officials will also be looking at ways to walk back what amount to permission slips the previous administration gave states to enact new requirements for Medicaid enrollment.

At the same time, the part of Medicare that covers hospital costs for seniors is running dangerously short on funds. It’s projected to become insolvent by 2024, two years earlier than expected. That’s closest to insolvency Medicare has been since 1971, when its trustees projected a two-year insolvency window.

But picking a CMS leader isn’t the administration’s top priority at the moment.

Becerra is still awaiting Senate confirmation, a process which has been delayed as Senate leaders fought over how to divide party control of the 50-50 Senate.

Confirmation hearings for Becerra aren’t expected to start until the week of Feb. 15 and could be pushed even later. 

And the CMS position isn’t the only top health-care slot Biden has yet to fill. He hasn’t yet named a nominee to lead the Food and Drug Administration, or nominees for more than a dozen other key posts at HHS.

Clipped from: https://www.washingtonpost.com/politics/2021/02/05/health-202-biden-narrows-picks-lead-medicare-medicaid-down-two-choices/

 
 

 
 

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CMS Failed to Flag Medicare Fee-for-Service Healthcare Fraud, Waste

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CMS did not use a method recommended by OIG for preventing payments to providers known to have high payment error rates.

 
 

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.

 
 

From 2014 to 2017, CMS had an improper payment rate of 60.7 percent, accounting for $3.5 million in healthcare fraud, waste, and abuse.

January 28, 2021 – The Centers for Medicare & Medicaid Services (CMS) and its contractors did not use Comprehensive Error Rate Testing (CERT) data to identify healthcare fraud or waste, according to a new Office of Inspector General (OIG) audit.

Data from the CERT program measures improper Medicare fee-for-service payments to providers. Previous OIG reports have recommended that CMS harness CERT data to determine error-prone providers and correct processes that contribute to these errors.

However, after reviewing CERT data from 2014 to 2017, the agency determined that CMS did not use the data to identify error-prone providers.

Of the $5.8 million reviewed by CERT, $3.5 million was an incorrect payment, making for an improper payment rate of 60.7 percent. OIG tracked these incorrect payments to 100 error-prone providers.

These providers had an error rate higher than 25 percent in each of the four CERT years analyzed and a total error amount of at least $2,500.

During the same time period, Medicare made $19.1 billion in FFS payments to those 100 error-prone providers.

In the audit, OIG recommended that CMS review this list of 100 error-prone providers and take action to reduce incorrect payments. This could include processes such as prior authorization, prepayment reviews, and postpayment reviews for these providers.

Like previous reports, OIG called on CMS to use annual CERT data to identify specific providers that have an increased risk of receiving improper payments. Additionally, OIG suggested CMS apply additional program integrity tools to monitor these providers.

CMS did not agree with OIG’s recommendations in written comments to the draft report.

“CMS disagreed with our methodology for identifying error-prone providers and suppliers. Additionally, CMS stated that it previously attempted to use CERT data to identify error-prone providers and suppliers but found that CERT data was ineffective for this purpose and discontinued the practice,” the agency said.

OIG reviewed CMS’s comments and maintained that its recommendations are valid in lowering improper payment rates.

“We maintain that CMS can improve its ability to detect these types of providers by using the provider-level CERT data along with its existing oversight efforts,” the OIG audit explained.

In recent years, aggressive corrective actions to reduce Medicare FFS improper payments in particular have led to less healthcare fraud, waste, and abuse. Data released in November of last year revealed that the Medicare FFS improper payment rate declined to 6.27 percent in fiscal year (FY) 2020 from 7.25 percent in FY 2019 leading to $15 billion in savings.

2020 was the fourth consecutive year that the Medicare FFS improper payment rate fell below 10 percent, CMS reported.

“President Trump made a clear commitment to protect Medicare for our seniors, and to do that we must ensure that fraud and abuse doesn’t rob the program of precious resources,” CMS Administrator Seema Verma said at the time of the data’s release.

“From the beginning this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions,” Verma continued.

However, based on OIG’s CERT data review that revealed over $19 billion in improper Medicare FFS payments to error-prone providers, CMS has room for improvement in terms of reducing fraud, waste, and abuse in the healthcare industry.

Clipped from: https://revcycleintelligence.com/news/cms-failed-to-flag-medicare-fee-for-service-healthcare-fraud-waste

 
 

 
 

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18 states back Arkansas on Medicaid work rule

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More than 1/3rd of states have registered their support of their right to use work requirements to further the objectives of the Medicaid program as SCOTUS considers the case.

 
 

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 — Arkansas should be able to set work requirements for some of its Medicaid recipients, 18 states told the U.S. Supreme Court this week.

The granting of federal waivers, which allowed these “demonstration projects” to proceed, was not “arbitrary and capricious,” they said.

Seventeen states signed an amicus curiae — or friend of the court — brief arguing that a lower court’s ruling is “flatly inconsistent with historical and current practice” and could lead to “potentially disastrous consequences.”

The Supreme Court announced in December that it would hear appeals involving the Arkansas and New Hampshire work requirements; both had been struck down by lower courts.

Arkansas hopes to persuade the court to allow it to use the work requirement for the Arkansas Works program, which uses Medicaid dollars to buy private insurance for low-income people.

The 17 states, all of which have Republican attorneys general, are: Alabama, Alaska, Arizona, Florida, Georgia, Indiana, Kansas, Louisiana, Mississippi, Missouri, Montana, Ohio, Oklahoma, South Carolina, Texas, Utah and West Virginia.

An 18th state, Nebraska, filed a separate brief arguing that the lower courts’ rulings were flawed; its attorney general is Republican as well.

With then-President Donald Trump in the White House, the U.S. Department of Justice defended the waivers.

Now that President Joe Biden is in office, the department’s stance is unclear.

A department spokesman Wednesday declined to comment on the litigation.

Under federal law, the secretary of the Health and Human Services Department is authorized to approve “any experimental, pilot, or demonstration project which, in the judgment of the Secretary, is likely to assist in promoting the objectives” of Medicaid and other state-run programs.

In legal filings, Arkansas has argued that the Arkansas demonstration project’s aim was “to test the hypothesis that conditioning Medicaid expansion benefits on work, education, or volunteering would lead to healthier outcomes for its beneficiaries.”

Critics argued that Arkansas Works was not designed to promote the objectives of the Medicaid program, and they portrayed the works requirement as punitive.

The requirement, which applied to Arkansans ages 19-49 covered under Arkansas Works, resulted in more than 18,000 people losing their health coverage over a nine-month period.

In many instances, the recipients met the requirements to receive the assistance but had failed to properly fill out the documentation.

At least 10 states have adopted Medicaid work requirements, according to the Kaiser Family Foundation.

The work requirements vary from state to state. In Arkansas, a recipient could meet the requirement — unless he was exempt — by working or doing other approved activities, such as volunteering and going to school.

Under the leadership of then-Gov. Mike Beebe, a Democrat, Arkansas expanded its Medicaid program under the 2010 Patient Protection and Affordable Care Act to cover adults with incomes of up to 138% of the poverty level.

After his election in 2014, Gov. Asa Hutchinson, a Republican, urged the Legislature to keep the program in place, later adding work or job-training requirements.

The tighter requirements helped persuade the Republican-dominated state Legislature to continue the program.

The administration of President Barack Obama declined to grant the waivers. The changes were subsequently approved by the Trump administration in March 2018 pursuant to Section 1115 of the Social Security Act, which authorizes waivers from federal Medicaid law.

After Arkansas Medicaid recipients sued, an Obama judicial appointee, U.S. District Judge James Boasberg of Washington, D.C., struck down the restrictions.

In a March 27, 2019, ruling, Boasberg found that federal Health and Human Services Secretary Alex Azar exceeded his authority in approving the requirements by failing to consider how they would affect the Medicaid program’s goal of providing health coverage to needy people.

On Feb. 14, the U.S. Court of Appeals for the District of Columbia Circuit said federal approval of the plan had been “arbitrary and capricious.”

In a unanimous three-judge appellate ruling, written by Senior U.S. Circuit Judge David Sentelle, the court found that in approving the project without considering its effect on Medicaid coverage, the Department of Health and Human Services violated the Administrative Procedures Act.

Sentelle, appointed by President Ronald Reagan, was joined by Judges Harry Edwards, appointed by President Jimmy Carter, and Cornelia Pillard, appointed by Obama.

Arkansas subsequently appealed to the U.S. Supreme Court.

In July, Arkansas Attorney General Leslie Rutledge maintained that the requirements would give able-bodied Arkansans an incentive to enter the workforce, helping them establish “a stronger, more resilient connection with their communities.”

One of the attorneys representing the Arkansas Medicaid recipients, Legal Aid of Arkansas’ Kevin De Liban, had referred to the workforce requirements as “termination traps.”

The Biden administration hasn’t said whether it will defend the waivers or rescind them.

Asked Tuesday about the dispute over work requirements, White House press secretary Jen Psaki referred questions about the ongoing litigation to the Department of Justice.

“I will say that President Biden does not believe, as a principle, it should be difficult for people to gain access to health care,” she said. “He’s not been supportive in the past, and is not today, of putting additional restrictions in place. And he’s spoken about that publicly, too.”

A spokeswoman for Rutledge said Wednesday that the work on the appeal continues.

“The Attorney General’s office looks forward to defending Arkansas Works at the U.S. Supreme Court so Arkansas may enrich the lives of our fellow Arkansans through commonsense community-engagement requirements.”

Officials with the National Health Law Program, which is helping to challenge the waivers, could not be reached for comment Wednesday.

Arkansas lawmakers will consider changing the state’s version of Medicaid expansion, with the state planning to seek a new waiver from the federal government for the program because the current waiver expires at the end of this year. The program provides health care coverage for about 300,000 low-income Arkansans.

The Legislature also will consider the spending authority for the program for the next fiscal year, which requires a third-fourths vote in the House and Senate. That requires 27 votes in the 35-member state Senate and 75 votes in the 100-member House of Representatives.

“Regardless of what the Supreme Court says on the work requirement, and whether it is authorized or not, we have to get our waiver by the Biden administration, so we want to shape this in a way that we can get the waiver,” Hutchinson said.

The community engagement requirements continue to have the support of the governor.

“We believe that we want to move people from dependence into independence and a part of that is making sure they are adequately trained for work,” Hutchinson said.

Information for this article was contributed by Andy Davis of the Arkansas Democrat-Gazette.

 
 

Clipped from: https://www.arkansasonline.com/news/2021/jan/28/18-states-back-arkansas-on-medicaid-work-rule/

 
 

 
 

 
 

 
 

 
 

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Executive Order on Strengthening Medicaid and the Affordable Care Act | The White House

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The new HHS administration has been instructed to open a special enrollment period for the exchanges and to review all policies and waivers approved in recent years to identify potential changes to nullify.

 
 

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.

 
 

By the authority vested in me as President by the Constitution and the laws of the United States of America, it is hereby ordered as follows:

     Section 1.  Policy.  In the 10 years since its enactment, the Affordable Care Act (ACA) has reduced the number of uninsured Americans by more than 20 million, extended critical consumer protections to more than 100 million people, and strengthened and improved the Nation’s healthcare system.  At the same time, millions of people who are potentially eligible for coverage under the ACA or other laws remain uninsured, and obtaining insurance benefits is more difficult than necessary.  For these reasons, it is the policy of my Administration to protect and strengthen Medicaid and the ACA and to make high-quality healthcare accessible and affordable for every American.

     Sec. 2.  Special Enrollment Period.  The coronavirus disease 2019 (COVID-19) pandemic has triggered a historic public health and economic crisis.  In January of 2020, as the COVID-19 pandemic was spreading, the Secretary of Health and Human Services declared a public health emergency.  In March of 2020, the President declared a national emergency.  Although almost a year has passed, the emergency continues — over 5 million Americans have contracted the disease in January 2021, and thousands are dying every week.  Over 30 million Americans remain uninsured, preventing many from obtaining necessary health services and treatment.  Black, Latino, and Native American persons are more likely to be uninsured, and communities of color have been especially hard hit by both the COVID-19 pandemic and the economic downturn.  In light of the exceptional circumstances caused by the ongoing COVID-19 pandemic, the Secretary of Health and Human Services shall consider establishing a Special Enrollment Period for uninsured and under-insured Americans to seek coverage through the Federally Facilitated Marketplace, pursuant to existing authorities, including sections 18031 and 18041 of title 42, United States Code, and section 155.420(d)(9) of title 45, Code of Federal Regulations, and consistent with applicable law.

     Sec. 3.  Immediate Review of Agency Actions.  (a)  The Secretary of the Treasury, the Secretary of Labor, the Secretary of Health and Human Services, and the heads of all other executive departments and agencies with authorities and responsibilities related to Medicaid and the ACA (collectively, heads of agencies) shall, as soon as practicable, review all existing regulations, orders, guidance documents, policies, and any other similar agency actions (collectively, agency actions) to determine whether such agency actions are inconsistent with the policy set forth in section 1 of this order.  As part of this review, the heads of agencies shall examine the following: 

(i)    policies or practices that may undermine protections for people with pre-existing conditions, including complications related to COVID-19, under the ACA;

(ii)   demonstrations and waivers, as well as demonstration and waiver policies, that may reduce coverage under or otherwise undermine Medicaid or the ACA;

(iii)  policies or practices that may undermine the Health Insurance Marketplace or the individual, small group, or large group markets for health insurance in the United States;

(iv)   policies or practices that may present unnecessary barriers to individuals and families attempting to access Medicaid or ACA coverage, including for mid-year enrollment; and

(v)    policies or practices that may reduce the affordability of coverage or financial assistance for coverage, including for dependents.

(b)  Heads of agencies shall, as soon as practicable and as appropriate and consistent with applicable law, consider whether to suspend, revise, or rescind — and, as applicable, publish for notice and comment proposed rules suspending, revising, or rescinding — those agency actions identified as inconsistent with the policy set forth in section 1 of this order.

(c)  Heads of agencies shall, as soon as practicable and as appropriate and consistent with applicable law, consider whether to take any additional agency actions to more fully enforce the policy set forth in section 1 of this order.

     Sec. 4.  Revocation of Certain Presidential Actions and Review of Associated Agency Actions.  (a)  Executive Order 13765 of January 20, 2017 (Minimizing the Economic Burden of the Patient Protection and Affordable Care Act Pending Repeal), and Executive Order 13813 of October 12, 2017 (Promoting Healthcare Choice and Competition Across the United States), are revoked.

(b)  As part of the review required under section 3 of this order, heads of agencies shall identify existing agency actions related to or arising from Executive Orders 13765 and 13813.  Heads of agencies shall, as soon as practicable, consider whether to suspend, revise, or rescind –- and, as applicable, publish for notice and comment proposed rules suspending, revising, or rescinding — any such agency actions, as appropriate and consistent with applicable law and the policy set forth in section 1 of this order.

     Sec. 5.  General Provisions.  (a)  Nothing in this order shall be construed to impair or otherwise affect:

(i)   the authority granted by law to an executive department or agency, or the head thereof; or

(ii)  the functions of the Director of the Office of Management and Budget relating to budgetary, administrative, or legislative proposals.

     (b)  This order shall be implemented consistent with applicable law and subject to the availability of appropriations.

     (c)  This order is not intended to, and does not, create any right or benefit, substantive or procedural, enforceable at law or in equity by any party against the United States, its departments, agencies, or entities, its officers, employees, or agents, or any other person.

                             JOSEPH R. BIDEN JR.

THE WHITE HOUSE,

    January 28, 2021.

 
 

Clipped from: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/28/executive-order-on-strengthening-medicaid-and-the-affordable-care-act/

 
 

 
 

 
 

 
 

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Threat of Medicaid block grants could be axed under Biden

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The new HHS administration has been ordered to review all policies and waivers that may restrict Medicaid “coverage.”

 
 

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.

 
 

 
 

Long-term care providers who opposed a federal proposal to turn the Medicaid program into a block grant system may get a solid stamp to their leanings under a new move by President Joe Biden. 

Biden on Thursday signed an executive order aimed at strengthening the Medicaid program and Affordable Care Act. Among its actions, the order tasks several agencies, including the  Department of Health and Human Services, to review all existing regulations, orders, guidance and policies related to Medicaid.

It also calls on them to examine “demonstrations and waivers, as well as demonstration and waiver policies, that may reduce coverage under or otherwise undermine Medicaid or the ACA.” 

Medicaid expert Joe Weissfeld noted that order could be the demise of block grants, which were pushed on a national scale by the Trump administration. He told Inside Health Policy the hope is that the order “marks the beginning of the end of work requirements, block grants, and attacks on reproductive health in the Medicaid program.”

A spokesman for the American Health Care Association once called block grants “an existential threat” to long-term care providers.

Last year, the Centers for Medicare & Medicaid Services announced its “Healthy Adult Opportunity” (HAO) program, which allowed participating states to receive a block grant for a specific population enrolled in Medicaid. That initiative was met with backlash from long-term care providers, among many others.CMS in mid-January approved an unprecedented demonstration for Tennessee to convert its Medicaid program into a block grant system.

 
 

Clipped from: https://www.mcknights.com/news/threat-of-medicaid-block-grants-could-be-axed-under-biden/

 
 

 
 

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Key MS House leader offers bill to restructure authority over Division of Medicaid

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Mississippi wants to take away Medicaid from the Governor.

 
 

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.

 
 

Rep. Trey Lamar

A new bill from the Mississippi House of Representatives, HB 1013 authored by House Ways and Means Chairman Trey Lamar (R) would establish a Medicaid Commission to oversee the Division of Medicaid currently operated under the instruction of the Governor’s office.

The proposed Commission would be made up of seven members. Three would be appointed by the Governor and four by the Lt. Governor initially, with later appointments made with the advice and consent of the state Senate. The Speaker of the House would have the ability to nominate two of the Lt. Governor’s appointees.

This marks a departure from the current circumstance as Medicaid is part of the executive branch with the Executive Director appointed by and reporting to the Governor.

The bill further clarifies the qualifications of the members and what experience they bring to the table, requiring some be a representative of Medicaid providers or from each Supreme Court or Congressional District.

It will then be up to the Commission of seven to appoint an Executive Director, who is required to either be a physician with administrative experience or a person holding a graduate degree in medical care administration, public health, hospital administration or something similar. The individual can also hold a bachelor’s degree with at least three years experience in management-level administration for policy development for Medicaid.

“House bill 1013 would essentially remove the Division of Medicaid from underneath the Governor and place a seven member board over the Division of Medicaid,” said Representative Lamar.

The language of the bill could cause some confusion when it states that it would “Abolish the Division of Medicaid and transfer the powers, duties, property and Employees of the Division to the Medicaid Commission.”

However, Lamar said this language is a matter of semantics. In laymen’s terms the bill would take the infrastructure and operations of the Division of Medicaid and rename the program under the Medicaid Commission within Mississippi Law. The substantive change would be that the authority would be moved from the Governor to the commission.

Rep. Lamar said with this change you would have seven sets of eyes over what has become a $6 billion industry. Medicaid is the largest budget in the state. There is roughly $1 billion of state dollars that go into the program and $5 billion of federal. While much of how those dollars is dictated by the federal government, the new board would also have input.

He said this commission would function similarly to the Department of Education, Institutions of Higher Learning, and Department of Health.

This would go into effect by July 1, 2021.

The appointment of the Medicaid Executive Director is at this time reserved for the Governor.

Currently, Medicaid is led by Executive Director Drew Snyder who was first appointed to the position by Governor Phil Bryant. The team also consists of a Deputy Executive Director, with several offices that work in conjunction with each other to accomplish regular work.

Medicaid serves roughly 720,000 Mississippians.

Mississippi’s Division of Medicaid was established in 1969 by the Mississippi Legislature.  It is housed within the Office of the Governor and is designated by state statute as the single state agency responsible for administering Medicaid. It currently employs over 1,300 people with 30 regional offices and over 80 outstations.

Lamar said this bill would not impact those jobs, but simply remove the division from under the Governor’s purview.

While tensions have been high in the past concerning Medicaid spending, the Division of Medicaid has made great strides fiscally since Snyder took over. For FY 2022, Medicaid did not request the typical $50 million deficit that the Legislature has become accustomed to in recent years.

Prior to the COVID-19 pandemic, the Division had roughly $40 million in special funds due to safe budgeting for the last few years. They have also continued to expand telemedicine opportunities, a program that was being prepped before the necessity of at home doctor visits due to social distancing.

In late 2020 Medicaid hearings, even providers complimented Snyder on the job he was doing to re-vamp the program, applauding his “open door” policy with everyone. Lamar echoed many of these sentiments, saying Snyder has done a great job over the Division.

The current concerns over Medicaid in Mississippi seem to revolve around Managed Care, the five percent reimbursement for providers and the difficult credentialing process. Many providers told lawmakers in October that they would like to see a more streamlined credentialing process.

Over the years there have been unsuccessful attempts by Legislative Democrats to expand Medicaid in Mississippi.  Republicans have fought the measure believing that the long term impact of substantially higher Medicaid enrollments would have a devastating effect on the state’s budget.  Many lawmakers believe that Snyder and his team have demonstrated Medicaid expansion is not necessary to run an efficient and effective program.

Lamar said a change like this is not unprecedented. It was only in the mid-80’s that the authority over the Division of Medicaid was handed over to the Governor.

“This would just be returning the state of Mississippi back to the way we use to do it and I think it makes sense,” said Lamar.

 
 

Clipped from: https://yallpolitics.com/2021/01/22/key-house-leader-offers-bill-to-restructure-authority-over-division-of-medicaid/