Category: Innovation Waivers

Health Policy News – September 2019

Introduction Since publishing our summer edition, the Health Policy News team has attended various conferences. We were thrilled to see many subscribers in person at the National Conference of State Legislatures Legislative Summit, as well as the National Academy of State Health Policy annual conference. In this edition, we share our insights (and relevant fact ...

Tennessee Releases Its Block Grant Plan

This month, Tennessee continued its pursuit of a Medicaid block grant, unveiling its draft Medicaid waiver amendment application on September 17th. Underpinning Tennessee’s months-long exploration of this model is the current federal administration’s interest in supporting these types of proposals—with implementation guidance expected to be released, but still under review, by the Office of Management ...

Critical Incident Management Solutions in Medicaid Long-Term Care

Medicaid agencies must assure the health and safety of their Home & Community-Based Services (HCBS) waiver program recipients by managing the reporting, investigation, and prevention of incidents.  Failure to do so poses a host of risks around compliance, fraud, and the safety of Medicaid recipients. States’ Medicaid agencies have administrative authority of their Medicaid Waiver ...

Recent Trends with OIG and CMS Related to Reporting Costs Associated with Waivers on the CMS-64

Claiming administrative costs to Medicaid waivers has become a targeted area of review by the Office of Inspector General (OIG) and Centers for Medicare and Medicaid Services (CMS). A number of state Medicaid agencies in various regions are facing potential disallowances or deferral of Medicaid administrative claims for failing to properly claim administrative costs to ...

Dishing from the 32nd National Academy of State Health Policy Annual Conference (#NASHPCONF19)

The Health Policy News team continued our summer conference travels and spent time in Chicago from August 21st-23rd at the 32nd Annual #NASHPCONF19. While we heard from many of our clients and listened to them speak about projects with which we are presently assisting, we also met many newcomers who were attending for the first ...

Insights from the AHIP National Health Policy Conference

Last week, America’s Health Insurance Plans (AHIP) held its annual health policy conference (#AHIPPOLICY) in Washington DC, with top industry leaders, regulators and policy makers convened to provide diverse voices and perspectives on today’s most urgent health care issues. The conference themes were familiar and front-of-mind topics: tackling the opioid epidemic, rising prescription drug costs, data ...

Health Policy News December Edition

Introduction As in years past, the primary focus of the December edition is highlighting some of the important topics we wrote about in 2018, while also foreshadowing policy trends that we believe will be of particular importance to states in 2019. Before many of you take a break to spend time with family and friends, ...

2018 Retrospective & Looking Forward to 2019

This past year brought increased flexibility for states related to both public health care programs and commercial health plans, with the Federal administration announcing numerous policies to give states more control over the design / regulation of the coverage offered to consumers. We saw first-of-their-kind waivers approved at the Federal level, including community engagement / ...

Early Lessons Learned from Implementing Community Engagement Requirements

Sixteen states have submitted Section 1115 Waivers to the Center for Medicare and Medicaid Services (CMS), requesting that a person’s eligibility to receive Medicaid be contingent on their participation in community engagement activities (also referred to as “work requirements”). States have flexibility to define the activities that would meet community engagement or work requirements, and ...

CMS Issues Guidance on Medicaid Behavioral Health Delivery System Reform

On November 13, 2018, the Centers for Medicare and Medicaid Services (CMS) released a letter to State Medicaid directors outlining a wide range of opportunities for states to design innovative delivery systems for adults and children with serious mental health conditions. The CMS letter offers guidance on strategies to improve care for such individuals using ...