Two things I wanted to share. First from CMS regarding the new vision for Medicaid as well as new notices about how CMS will operate with states as it relates to 1115 waiver applications (important because Il has submitted one). Second is a notice about an opportunity to comment on a class action consent decree and fair hearing around kids with mental health or behavioral health needs getting access to services EPSDT.
From CMS Press Release:
Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program
New Policies Help Ensure States Can Focus More Resources, Time Achieving Positive Health Outcomes for Beneficiaries
Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.
“Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said Administrator Verma. “We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential.”
Verma emphasized her commitment to “turn the page in the Medicaid program” by giving states more freedom to design innovative programs that achieve positive results for the people they serve and pledged to remove impediments that get in the way of states achieving this goal.
She announced several new policies and initiatives that break down the barriers that prevent state innovation and improvement of Medicaid beneficiary health outcomes:
Web Site Content on Section 1115 Demonstrations: CMS updated Medicaid.gov to give states a clearer indication of how their reform strategies might align with a core objective of the Medicaid program: serving the health and wellness needs of the nation’s vulnerable and low-income individuals and families. The revised web site content signals a new, broader view of Section 1115 demonstrations, in which states can focus on evidence-based interventions that drive better health outcomes and quality of life improvements. The update signals CMS’s willingness to work with state officials requesting flexibility to continue to provide high quality services to their Medicaid beneficiaries, support upward mobility and independence, and advance innovative delivery system and payment models.
In a significant shift from prior policies, in speaking about the new approach to Section 1115 demonstrations, Verma emphasized the agency’s commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty. As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative, she said. During her remarks, the Administrator made it clear that CMS will openly consider proposals that promote community engagement and work activities.
Streamline and Improve 1115 Demonstration, State Plan Amendments, and 1915 Waiver Processes: CMS released several new policies that improve federal and state program management, specifically through improvements in the review, approval process, and monitoring of 1115 Demonstrations and Medicaid and Children’s Health Insurance Program (CHIP) state plan amendments (SPA) and 1915 waivers. Taken together, these policies include provisions that will allow states to:
- Request approval for certain 1115 demonstrations for up to 10 years;
- More easily pursue “fast track” federal review, which makes it easier for states to continue their successful demonstration programs;
- Spend time administering innovative demonstrations by reducing certain 1115 reporting requirements;
- Expedite SPA and 1915 waiver efforts through a streamlined process and by participating in a new “within 15-day” initial review call with CMS officials.
In addition, the policies will improve how waivers and demonstration projects are monitored and evaluated. Waivers and demonstration projects that are less complex and have been running smoothly will require much less reporting, and waivers and demonstration projects that have a good track record of producing positive results will find an easier path to renewal. In her remarks, the Administrator underscored that these new policies were intended to relieve the regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.
Creation of First-Ever Medicaid and CHIP Scorecards: CMS is in the early stages of developing Scorecards that will provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes. In her remarks, Verma said that the Scorecards were a “historic opportunity” to demonstrate to taxpayers that their hard-earned tax dollars were being spent appropriately. In addition, the reporting will provide validation to Medicaid beneficiaries that the $558 billion spent on Medicaid is producing positive results and improved health outcomes.
- To visit the new updated Medicaid 1115 Demonstration Project page click here.
- To view the Section 1115 Demonstration Process Improvements Informational Bulletin, click here.
- To view the State Plan Amendment and 1915 Waiver Informational Bulletin, click here.
Hearing on Consent Decree for Kids Wanting to Access EPSDT
The N.B. v. Norwood lawsuit was filed in 2011 on behalf of Medicaid-eligible children under the age of 21 in the State of Illinois seeking certain mental and behavioral health services under the Early and Periodic Screening, Diagnostic, and Treatment (“EPSDT”) requirement of the Medicaid Act. On February 13, 2014, the United States District Court for the Northern District of Illinois certified the case as a class action for the following class of individuals: “All Medicaid-eligible children under the age of 21 in the State of Illinois: (1) who have been diagnosed with a mental health or behavioral disorder; and (2) for whom a licensed practitioner of the healing arts has recommended intensive home- and community-based services to correct or ameliorate their disorders.”
On October 27, 2017, Federal Judge Jorge Alonso entered an order granting preliminary approval to a Consent Decree that would resolve the class action. The proposed Consent Decree would provide eligible Class Members the opportunity to access a continuum of Medicaid-authorized mental and behavioral health services, including home- and community-based services, that may be needed to address their mental or behavioral health disorders. Judge Alonso will conduct a fairness hearing on December 19, 2017 to determine whether the terms of the Consent Decree are fair, reasonable, adequate, and should be approved by the Court. For more information on the Consent Decree, the fairness hearing, and the rights of Class Members, please see the documents available below.
N.B. v Norwood Documents
- Notice of Proposed N.B. v Norwood Class Action Settlement and Hearing (pdf)
- B. v Norwood Settlement Agreement (Preliminarily Approved) (pdf)
- Order Granting Preliminary Approval of Settlement Agreement and Setting Fairness Hearing (pdf)
For more information on the Proposed Consent Decree, the Fairness Hearing, and the rights of Class Members, please see the Notice and Proposed Consent Decree linked above and the following website:https://www.illinois.gov/hfs/info/legal/Pages/N.B.vNorwood.aspx.
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