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Medicaid

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Message from The Centers for Medicare & Medicaid Services (CMS):

The Centers for Medicare & Medicaid Services (CMS) is continuing to monitor and assess the impact that the cyberattack on UnitedHealth Group’s subsidiary Change Healthcare has had on all provider and supplier types. Today, CMS is announcing that, in addition to considering applications for accelerated payments for Medicare Part A providers, we will also be considering applications for advance payments for Part B suppliers.

Over the last few days, we have continued to meet with health plans, providers and suppliers to hear about their most pressing concerns. As announced previously, we have directed our Medicare Administrative Contractors (MAC) to expedite actions needed for providers and suppliers to change the clearinghouse they use and to accept paper claims if providers need to use that method. We will continue to respond to provider and supplier inquiries regarding MAC processes.

CMS also recognizes that many Medicaid providers are deeply affected by the impact of the cyberattack. We are continuing to work closely with States and are urging Medicaid managed care plans to make prospective payments to impacted providers, as well.

All MACs will provide public information on how to submit a request for a Medicare accelerated or advance payment on their websites as early as today, Saturday, March 9.

CMS looks forward to continuing to support the provider community during this difficult situation. All affected providers should reach out to health plans and other payers for assistance with the disruption. CMS has encouraged Medicare Advantage (MA) organizations to offer advance funding to providers affected by this cyberattack. The rules governing CMS’s payments to MA organizations and Part D sponsors remain unchanged. Please note that nothing in this statement speaks to the arrangements between MA organizations or Part D sponsors and their contracted providers or facilities.

If you have any questions, please contact Fady Sahhar.

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Image by photosforyou from Pixabay

RCPA member Achieva and the Pennsylvania Health Law Project are hosting a webinar titled “Understanding Medicaid Home and Community-Based Waivers for People With Disabilities” from 10 am – 12 pm on Tuesday, April 2, 2024. Led by Janice Meinert from the Pennsylvania Health Law Project, the webinar will explore Pennsylvania’s Medicaid Home & Community-Based Waiver programs. Topics include eligibility criteria, the application process, available services, and annual waiver clinical eligibility redeterminations. For more details and registration, visit Achieva’s website. This project receives funding from the Pennsylvania Developmental Disabilities Council. For accessibility accommodations, please contact Patty Yerina. If you have additional questions, you may contact Jim Sharp, RCPA Mental Health Policy Director.

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Today, Secretary Arkoosh presented an overview of the proposed Department of Human Services (DHS) budget in the Governor’s proposed budget he unveiled earlier this week. Governor Shapiro is prioritizing investments in IDD home and community-based service providers so that they can pay competitive rates to attract and retain staff who provide these life-changing services to Pennsylvanians.

Secretary Arkoosh stated, “It’s time to make a change,” and people need “the right service at the right time.” PA is about to embark on a multi-year wait list plan.

In September, Governor Shapiro directed DHS’s Office of Developmental Programs to begin an immediate evaluation and assessment of the rates paid to intellectual disability and autism programs that employ direct support professionals. Building on that, the governor is proposing an increase in reimbursement rates by 12%, which will invest a total of over $480 million, divided by state ($217 million) and federal ($266 million) funding for programs that support ID/A. It is proposed that the rate increase will become effective July 2024. Additionally, one-time supplemental payments to support staffing recruitment and retention were announced. These funds are anticipated to be distributed to providers in May or June 2024 and will total $109 million.

ODP will be working closely with counties to shift to management by budget rather than slots, and effective immediately, the department is adding 1,250 in Community Living and 250 in Consolidated people to the waiver capacity ($78 million in funding).

This budget also invests $934,000 to add American Sign Language and English interpreter services to program serving this population as a distinct service.

While this is very positive news for the ID/A community, this is the proposed budget. We all need to continue to advocate with legislators to support this proposal and give the ID/A services the support they need. Please share your stories with your local legislator and participate in our upcoming capitol day on March 19, 2024. You can register to participate in the event here. Also, we ask that you take the time to thank Governor Shapiro for hearing our voices and addressing our critical needs.

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Photo by Markus Winkler on Unsplash

The Office of Mental Health and Substance Abuse Services (OMHSAS) successfully collaborated with the Centers for Medicare & Medicaid Services (CMS) to revise Pennsylvania’s State Medicaid Plan for Certified Peer Specialists (CPS). The changes aim to enhance workforce opportunities, break down barriers, and establish a robust crisis system. The updated qualifications for aspiring CPS include:

  1. Elimination of the self-identification requirement for Serious Mental Illness, replaced with an attestation of a mental health diagnosis and a stage of recovery to support others;
  2. Removal of the high school diploma requirement and instead, as part of the Pennsylvania Certification Board (PCB) application, applicants will be providing narratives on how they achieved recovery and wellness; and
  3. The mandatory recent employment or volunteer experience within the last three (3) years has been removed.

Details on these changes can be found in the updated State Plan here (scroll down to 0013 Attachment 3.1A-3.1B, page 88). OMHSAS will issue a forthcoming bulletin, and inquiries can be sent electronically.

If you have further questions, please contact RCPA Policy Director Jim Sharp.

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On January 26, 2024, the Centers for Medicare & Medicaid Services (CMS) forwarded the final Medicaid Access Rule (CMS-2442-F) to the Office of Management and Budget (OMB) for the last review step before Federal Register publication.

The proposed Medicaid Access Rule contained a number of policies, including the much-discussed 80/20 provision that would require 80 percent of all Medicaid payments to be spent on direct care workers and direct service professionals compensation for personal care services.

RCPA commented on these proposed regulations and will continue to monitor progress with our federal partners. The OMB is expected to issue its comments in April. If you have questions, please contact RCPA Policy Director Fady Sahhar.

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