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CMS Publishes Proposed Rule on Medicaid Fiscal Accountability
On November 12, the Centers for Medicare and Medicaid Services (CMS) issued a Notice of Proposed Rulemaking(NPRM) on Medicaid fiscal accountability. The NPRM covers a wide variety of Medicaid financing structures and mechanisms that CMS views as posing risks to the fiscal integrity of the program, including supplemental payment arrangements, provider taxes and donations, and sources of state share of Medicaid funding. The rule proposes a number of new reporting requirements and practices that CMS believes will give it certainty in assessing and approving state financing arrangements, and directly responds to concerns raised by federal oversight entities such as the Government Accountability Office and the U.S. Health and Human Services Office of the Inspector General.
The National Association of Medicaid Directors (NAMD) published the following overview in their November 19, 2019 Bi-Weekly Update.
A high-level overview of the rule's topics includes:
- Definitions: Defines in regulation what constitutes a Medicaid "base" payment and a "supplemental" payment
- Three-Year Sunset: Requires any supplemental payment or tax waiver to automatically sunset after three years, with state option to renew the arrangement after CMS review and approval;
- Provider-Level Reporting: Requires states to report each provider's received supplemental payment level, the specific authority the state is using to make the supplemental payment, and the source of the state share of the supplemental payment;
- Requirements on Provider Sources of Non-Federal Share: Clarifies that states using Intergovernmental Transfers (IGTs) or Certified Public Expenditures (CPEs) must draw the IGT or CPE from a legitimate state or local tax source; requires that providers receiving a supplemental payment retain 100 percent of that supplemental payment to prevent recycling of payments to draw down additional federal share; new requirements on ownership transfers and when such transfers do not constitute a legitimate change of ownership for purposes of additional Medicaid payments;
- Disproportionate Share Hospital (DSH) Payments: New data elements for DSH audits to quantify individual hospital findings in the audit; new requirements on how states must either repay or redistribute identified DSH overpayments; and
- Health Care-Related Taxes and Donations: Clarifies rules around masking impermissible tax and donation schemes to prohibit arrangements that pose undue burdens on the Medicaid program, such as taxing a managed care plan's Medicaid line of business at a significantly higher rate than other business.
This NPRM was formally published in the Federal Register on November 18 with a 60-day comment period closing on January 17, 2020.
As noted, this NPRM covers a broad range of topics. The area that will most likely directly affect School-Based Medicaid billing is within the Requirements on Provider Sources of Non-Federal Share, specifically supplemental payments and state share match sources.
If you have any concerns or questions, please reach out to:
John Hill, NAME Executive Director Amy Edwards, NAME Governmental Affairs
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Commonwealth of Kentucky, Cabinet for Health and Family Services (CHFS) has received final approval for a Medicaid state plan amendment that will expand health services in schools. “Approval for this amendment is a game changer,” said CHFS Secretary Adam Meier. The full release can be accessed by clicking on the following link:
https://chfs.ky.gov/News/Documents/nrstudenthealthservices.pdf.
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Medicaid covers more than 45 million children in more ways than one. The program provides comprehensive care – including school-based services like speech and physical therapy, counseling, and transportation – to ensure our kids have healthy futures. Here are the top ten facts you should know about how Medicaid serves children and their families. Click on the link to access this fact sheet:
http://modernmedicaid.org/wp-content/uploads/2018/10/MMA_Top10-ChildrenFamilies-Print.pdf
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The Georgetown University Center of Children and Families just released a report looking at how the school and health sectors can collaborate to improve student success, with a particular emphasis on the role of Medicaid and CHIP.
The report details how recent changes to federal education law, new grant programs and revised Medicaid rules have opened the door for better collaboration, but obstacles remain in both the logistics and the costs of offering school-based health care.
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Department of Justice Medicaid Fraud report on a School-Based Health Center that was operated by a Federally Qualified Health Center in Louisiana. A Louisiana-based licensed clinical social worker pleaded guilty today for his role in a scheme to defraud Medicaid. Click below for the full report:
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Community Catalyst, Healthy Schools Campaign and Trust for America’s Health published a new issue brief on state activity regarding school based services and Medicaid.
Issue Brief: https://docs.google.com/document/d/1u0j1so-se8ohhyl7AcHaaXlGX5l3s0PN2cuIDejXZQw/edit
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On March 11, the Trump Administration released its FY 2020 budget proposal. Also released is a Health and Human Services budget in brief document, providing a more granular look at Medicaid budget proposals and other health Programs. Both Links can be accessed below:
https://www.whitehouse.gov/wp-content/uploads/2019/03/budget-fy2020.pdf
https://www.hhs.gov/sites/default/files/fy-2020-budget-in-brief.pdf
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As school districts that are faced with a growing number of students with critical health and mental healthcare needs, AASA, The School Superintendents Association, is seeking a solution to enable more communities to participate in the Medicaid program. The report, summary and School-Based Services recommendation report by Bob Bundy, Rokay Services Group can be assessed by clicking on the following links:
http://www.aasa.org/uploadedFiles/Policy_and_Advocacy/Resources/AASA_Medicaid_Report_FINAL.pdf
http://www.aasa.org/uploadedFiles/Policy_and_Advocacy/Resources/AASA_Medicaid_ExecSummary_FINAL.pdf
http://www.rokayservices.com/images/Documents/School_Medicaid_Improvements.pdf
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Recently, the Kaiser Family Foundation (KFF) comprehensively updated its database tools which track Medicaid benefits across the states. This effort updates the previous database, which was based on 2012 information, to include more recent benefit snapshots and include Medicaid behavioral health benefits. The databases can be accessed by clicking on the following links:
Overall benefits database: https://www.kff.org/data-collection/medicaid-benefits-database/
Behavioral health service database: https://www.kff.org/data-collection/medicaid-behavioral-health-services-database
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The National Alliance for Medicaid in Education would like to share the following news:
The State of Massachusetts recently announced that an expansion of its School-Based Medicaid Program will take effect July 1, 2019. For more information about this expansion, which is a result of the December 15, 2014 change in the CMS free-care policy:
www.mass.gov/files/documents/2018/05/23/sbm_31_1.pdf