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The Employment First Community of Practice webinar on “Value, Outcome and Performance-Based Payment Methodologies to Advance Competitive Integrated Employment in State Medicaid Long-Term Services and Supports (LTSS) Systems and Managed Care LTSS Systems” is available for viewing in the archives. The webinar presents examples of state Medicaid LTSS systems, some that are using managed care and some that are not, that have designed and implemented value-based purchasing and outcome-based reimbursement methods to advance Employment First and Competitive Integrated Employment.

Visit here to view “Value, Outcome and Performance-Based Payment Methodologies to Advance Competitive Integrated Employment in State Medicaid Long-Term Services and Supports (LTSS) Systems and Managed Care LTSS Systems.”

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From ANCOR:

Happy Friday, ANCOR Members! Two months after President Biden signed the American Rescue Plan into law, CMS finally released its guidance to states on the 10% FMAP bump dedicated to HCBS. We are still analyzing it carefully, but initially it appears that stakeholder input was carefully considered. Of immediate significance:

  • CMS is permitting states an additional three 30 day episodes of retainer payments. We advocated long and hard for that, so this is a major win!
  • Time frame for states to spend the additional FMAP funds was extended through March 31, 2024;
  • States must maintain HCBS provider payments at a rate no less than those in place as of 4/1/21;
  • Gives specific examples re states which implemented temporary changes through the Appendix K template and how they are expected to retain those changes;
  • Specific examples re supplementing vs. supplanting;
  • Allowable uses include:
    • Payment rates with the expectation of providers to increase compensation, leave benefits, specialized payments, etc.
    • PPE & Testing Supplies
    • Activities to recruit and retain DSPs, including incentive payments, training specific to the pandemic
    • Support for family caregivers, including PPE and payment as a service provider
    • Assistive Technology, including internet activation costs, staffing ,etc.
    • Transition Support

Below is an overall summary of the full guidance:

Since the beginning of the pandemic, ANCOR alongside our disability partners has worked tirelessly to address those needs – finding new ways to deliver services and increase capacity, ensuring the needs of people with disabilities have been considered at every step of the COVID-19 response, and ensuring that the magnitude of the needs are understood.

As a result of that advocacy, the American Rescue Plan Act of 2021 (ARP) included several provisions to help address these unmet needs. One of them is a temporary, but significant, increase in federal funding for home and community-based services (HCBS). Specifically, states can receive a 10 percentage-point increase to the federal medical assistance percentage (FMAP) they receive for certain Medicaid expenditures for HCBS. This “FMAP bump” is available for one year, from April 1, 2021 to March 31, 2022.

In a letter to State Medicaid Directors issued Thursday, the Centers for Medicare & Medicaid Services (CMS) provided states with guidance for receiving the funding. The letter provides more precise details, but services and activities can be provided through a variety of different Medicaid HCBS programs, and a wide variety of services and supports that both older adults and people with disabilities rely upon are eligible. For example, states can claim additional federal funds for:

  • HCBS waiver services
  • Home health services
  • Private duty nursing
  • Personal care services
  • Self-directed personal care services
  • Case management
  • School-based services
  • Rehabilitative services
  • Program of All Inclusive Care for the Elderly (PACE)

Additional funding also can be used for a range of activities that help increase community living options. The following are just a few of the many examples described in CMS’ letter:

  • Adding new HCBS services.
  • Providing more of the same services to people who already receive them. For example, providing additional hours of personal care services.
  • Providing services to individuals on HCBS waiting lists.
  • Providing services that help people avoid institutionalization, or that help them return to the community from institutions.
  • Supporting the direct care workforce through increased pay or benefits, recruitment and training activities, or expanding self-directed programs.
  • Providing supports for family caregivers, including training and respite services.
  • Providing assistive technology for people with disabilities, including internet activation costs.
  • Assisting with access to COVID-19 vaccines, including scheduling appointments, transportation and in-home vaccination.
  • Providing personal protective equipment.
  • Expanding provider capacity for mental health and substance use disorders, as well as expanded rehabilitation services.
  • Quality improvement activities.
  • Some No Wrong Door functions, such as developing informational websites, automating screening and assessment tools, and conducting marketing and outreach campaigns.

(Note that services paid for through administrative match, such as those offered through the Long-Term Care Ombudsman program and certain No Wrong Door program activities, are not eligible.)

An important condition for receiving this funding is that states cannot decrease their own funding of HBCS. In other words, states cannot use the additional federal funding instead of state funds; the funds must be used in addition to the state’s own investments. They also may not cut HCBS services during this time. That means states may not eliminate covered services or reduce the amount, duration or scope of those services. In addition, they may not impose stricter eligibility requirements for HCBS programs and services than were in place on April 1, 2021 or reduce provider payments.

***States can contact HCBSincreasedFMAP@cms.hhs.gov if they have questions about the services which can claim the increased FMAP.

——————————
Shannon McCracken
Vice President of Government Relations
ANCOR
606-271-3555
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The Senate Aging and Youth Committee has announced an upcoming public hearing on Thursday, May 20, 2021 at 11:00 am. This public hearing will focus on the current status and needs of long-term care facilities one year after COVID-19. This hearing will be live streamed and will also be archived for future viewing.

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The Centers for Medicare & Medicaid Services’ (CMS) accelerated payment program provides necessary funds when there are disruptions in claims submission and/or processing. The Coronavirus Aid, Relief, and Economic Security (CARES) Act (P.L. 116–136) expanded the program to include not only acute care hospitals, but also children’s hospitals, certain cancer hospitals, and critical access hospitals. CMS further expanded eligibility for accelerated/advance payments during the COVID-19 public health emergency (PHE) to all Medicare providers and suppliers.

On April 1, 2021, CMS issued a notice “Repayment of COVID-19 Accelerated and Advance Payments Began on March 30, 2021” for all Medicare providers and suppliers who requested and received COVID-19 Accelerated and Advance Payments (CAAPs) from CMS due to the COVID-19 PHE. It notifies providers that CMS began recovering the CAAP payments as early as March 30, 2021 (depending upon the one-year anniversary of when a provider received their first payment). The notice also provides information on how to identify recovered payments. Some highlights from the article include:

  • Accelerated payments function as a loan and must be repaid to CMS in full. The Continuing Appropriations Act, 2021 and Other Extensions Act, enacted on October 1, 2020, established new repayment terms for accelerated/advance payments. Among other provisions, the new terms include:
    • One year (from date payment was issued) before repayment begins — hospitals begin repayment as early as April 2021;
    • 25 percent withhold of Medicare claims during the first 11 months of repayment, followed by a 50 percent withhold during the subsequent six months; and
    • 4 percent interest applied to any remaining balance at the end of the repayment period.

The accelerated payments provided a critical lifeline to health systems during this PHE. The requirement to repay these funds could place health systems in financial distress while trying to recover from the pandemic. RCPA is requesting feedback from members on the impact of the accelerated payment relief plan. Please take a few minutes and respond to the following questions:

  1. Are you/your organization aware of the Accelerated Payment Relief program from CMS?
  2. Have you taken advantage of this?
  3. Are there any issues with the repayment?
  4. Have you been involved in any lobbying efforts to:
    1. Get this to better payment terms (e.g., interest rate, timing)?
    2. Move this to loan forgiveness?
  5. Have you contacted any state or federal legislators? If so, whom?
  6. Has your organization also received Provider Relief Funding and/or any other extraordinary CARES Act Funding?
  7. If so, has this impacted your interest in pursuing action relative to the Accelerated Payment Relief?
  8. Any additional comments?

Please send your responses to Melissa Dehoff by Wednesday, May 26, 2021.

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Image by Katja Fuhlert from Pixabay

Yesterday, the Advisory Committee on Immunization Practices (ACIP) recommended use of the Pfizer-BioNTech COVID-19 vaccine for children ages 12–15. This follows an expanded emergency use authorization issued by the Food and Drug Administration earlier this week.

Parents can now begin to schedule their children ages 12 and up through any vaccine provider administering Pfizer. You can find a vaccine provider administering Pfizer near you.

The authorization follows a Phase 3 clinical trial with 2,260 participants. Data from this trial showed that the vaccine was 100 percent effective in preventing cases of COVID-19, and the immune response was just as strong, and potentially stronger, when compared to clinical trial participants aged 16 through 25 years considered in the vaccine’s initial authorization. Side effects experienced by some participants in the clinical trial were similar to what was experienced by older teenagers and adults — tiredness, headaches, muscle pain, and fever. As with all other vaccines, Pfizer, the FDA, and the CDC will continue to monitor for safety moving forward.

While children and adolescents are not as likely to experience severe effects from COVID-19 as older adults, they are still able to transmit the virus if they contract it. Vaccine uptake in children and teenagers and protecting them from catching and further spreading the virus can help reduce community transmission and protect more vulnerable people. There is also still great risk and uncertainty surrounding this virus and its long-term effects, and this vaccine is a way to help keep more people safe from COVID-19. More information about the Pfizer vaccine’s extended emergency authorization is available from the FDA and through a fact sheet for recipients and caregivers.

We understand that there may be questions as children and their caregivers consider their options regarding these vaccines. We hope that families and caregivers will continue to trust the rigorous testing and scrutiny these vaccines undergo before emergency authorization and choose this option to protect their children from COVID-19. If you have further questions, please contact RCPA Children’s Director Jim Sharp.

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The recording of the Finance and Reimbursement Committee meeting is available on the members only section of RCPA’s website, which is accessible here. The PowerPoint from the April 2021 Mercer/ODP webinar regarding Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/ID) budgets is available here.

For more information about the Employee Tax Credit program and Synergi, follow this link to the Synergi Partners RCPA landing page. You can also reach out directly to Jeff Walker or Clint Foster.

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Today CMS released guidance to the State Medicaid Directors regarding the 10% increased Federal Medicaid Assistance Percentage (FMAP) for certain Medicaid expenditures for Home and Community-Based Waiver Services (HCBS). States must use the funds to supplement and not supplant state funds expended for HCBS Waiver Services in effect as of April 1, 2021, and states must use state funds equivalent to the amount of federal funds attributable to the increased FMAP to implement or supplement the implementation of one or more activities to enhance, expand, or strengthen HCBS under the Medicaid program.

The purpose of this letter is to provide guidance to states on the implementation of section 9817 of the American Rescue Plan (ARP), as well as to describe opportunities for states to strengthen the HCBS system in response to the COVID-19 Public Health Emergency (PHE), increase access to HCBS for Medicaid beneficiaries, adequately protect the HCBS workforce, safeguard financial stability for HCBS providers, and accelerate long-term services and supports (LTSS) reform under section 9817 of the ARP.

This increased federal funding can help states increase community living options for people with disabilities, in accordance with Title II of the Americans with Disabilities  Act, 42 U.S.C. §§ 12131–12134, as interpreted by the Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), which requires public entities to administer services to individuals with disabilities in the most integrated setting appropriate to their needs.

In addition, this letter updates Medicaid retainer payment policy for HCBS providers during the COVID-19 PHE.

The letter outlines additional guidance.

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