Tag: waivers

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 ...

Health Policy News – April 2019

Introduction In this month’s edition of Health Policy News, we delve into two of last month’s breaking Federal litigation updates: the decisions issued in cases regarding the Association Health Plan Final Rule and the use and operationalization of Medicaid work requirements. As both decisions reverse course on recent health policy developments, we analyze their likely ...

Work Requirement Waiver Approvals Vacated in Kentucky and Arkansas

On March 27, 2019,  Judge James Boasberg of the United States District Court for the District of Columbia issued rulings on back-to-back cases addressing work requirement eligibility criteria included in Section 1115 waiver applications submitted by the states of Arkansas and Kentucky. Judge Boasberg again ruled against the implementation of a Medicaid work requirement in Kentucky, while ...

Health Policy News – March 2019

Introduction With the first quarter of the new year coming to a close, we are taking this opportunity to do a national review of major state health policy activity in 2019. Nineteen new governors were sworn into office in January, and many of them assumed office with health care at the top of their agendas. ...

Newly-Elected Governors Set Their Sights on Healthcare Reforms

The new year brought changes to state leadership across the nation, with 19 governors newly entering the corner office—seven of whom took over from an administration on the other end of the political spectrum. This refresh has brought a surge of new ideas and energy in the realm of state health policy. Below, we highlight

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 ...

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 / ...