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Tags Posts tagged with "Medicaid"

Medicaid

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RCPA continues its efforts to update members on the White House funding freeze while partnering with the National Council for Mental Wellbeing and ANCOR in examining the implications stemming from the White House Office of Management and Budget’s (OMB) January 27 memorandum temporarily freezing federal disbursements to many federal programs.

The National Council has provided the following update:

Federal agencies have been directed to fill out a spreadsheet as part of an analysis by Feb. 7 to ensure compliance with the president’s most recent executive orders. This is a breakdown of which health programs are included in this latest action.

Notably, we recognize conflicting guidance has been issued. While the above report identifies Medicaid programs, a Q&A document from the administration notes that Medicaid will continue without pause. As of Tuesday morning, all 50 states reported outages of their Medicaid online portals, and the Trump administration has stated they are aware of the outages and expect the portals to be back online shortly.

Also, several groups have taken action to block this funding freeze. As of this writing, several Democratic state attorneys general said they would ask a court to block the freeze from taking effect. Several groups representing nonprofits, public health professionals and small businesses have already filed suit in D.C. asking the court to prevent the freeze from continuing. On Tuesday evening, U.S. District Court Judge Loren L. AliKhan issued a temporary stay on the funding freeze until Feb. 3 at 5:00 pm ET.

The funding freeze may lead to project delays or cancellations, resulting in layoffs of workers involved in these programs, and may ultimately increase the unemployment rate, making it vital lawmakers understand the impact of this freeze on communities across the country.

Most notable are the concerns with the intersects of Medicaid funding though the information that has been released. The Q&A document states:

Q: Is this a freeze on benefits to Americans like SNAP or student loans?

A: No, any program that provides direct benefits to Americans is explicitly excluded from the pause and exempted from this review process. In addition to Social Security and Medicare, already explicitly excluded in the guidance, mandatory programs like Medicaid and SNAP will continue without pause.

RCPA will continue to communicate new developments with members as they emerge. If you have any questions, please contact your RCPA Policy Director.

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The Centers for Medicare & Medicaid Services (CMS) has made updates to the training schedule for Home and Community-Based Services (HCBS) provisions of the Medicaid Access Rule. The new training session dates and tentative topics for each session can be found below. These dates and topics are subject to change.

  • May 14, 2025, 3:00 pm ET: Timely Access, Waiting Lists, Person-Centered Planning Reporting Requirements & Minimum Performance Levels, and Website Requirements
  • June 11, 2025, 3:00 pm ET: Institutional Rule Provisions*

*Nursing Facility and Intermediate Care Facilities for Individuals with Intellectual Disabilities Rate Transparency provisions finalized in CMS-3442-F: Medicare and Medicaid

You can learn more about the training series and register for upcoming sessions on the HCBS Provisions of the Medicaid Access Rule Training Series registration web page.

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In an effort to gain a better understanding of providers’ ongoing needs and challenges in addressing third party liability (TPL) claims, RCPA is requesting that our members complete the following TPL Survey. This survey was designed to capture critical barriers so as to develop strategic pathways to ensuring access and equity.

In January 2024, Governor Shapiro announced that commercial insurers would be required to meet their obligations under Pennsylvania law to provide coverage for autism benefits by categorizing autism services as a mental health benefit. With this action, all autism services will be treated as mental health services, leading to greater mental health parity for those with autism spectrum disorders. The goal of the Shapiro Administration’s legislation is to improve much-needed access to services for individuals diagnosed with autism, a challenge that the Commonwealth has faced for decades.

As providers of mental health, autism services, and substance abuse disorders, our members treat a vast array of individuals who are insured by either commercial insurance, Medicaid insurance, or both. For those who have just Medicaid, billing is simple: providers bill the Medicaid payor, and they pay the claim. The same is true for those who have just commercial insurance if the provider is in network with the commercial insurance carrier.

Complications occur when an individual has both commercial insurance and Medicaid. Coordination of Benefits (COB) requires that the commercial insurance is billed first, and then Medicaid pays what is not covered. Services like the delivery of Applied Behavior Analysis (ABA) or Intensive Behavioral Health Services (IBHS) are two good examples of services that can fall into this category.

With this survey, we hope to gather information that will assist RCPA and members in addressing the barriers in insurance coverage for children, families, and individuals in Pennsylvania. We thank you for taking the time to complete the survey so that we can continue to seek solutions to access services in our communities.

If you have any questions, please contact RCPA Policy Associate Emma Sharp.

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Thursday, December 5, 2024
2:00 pm – 3:00 pm ET
11:00 am – 12:00 pm PT
Register Here

This spring, the Centers for Medicare & Medicaid Services (CMS) finalized the highly anticipated “Ensuring Access to Medicaid Services” rule (or the “Access Rule”) that, among other things, updates program standards and processes for Medicaid home- and community-based services (HCBS), including HCBS for people with intellectual and developmental disabilities (I/DD). Individuals with I/DD rely on Medicaid HCBS to support their independence and ability to live at home in their communities. The changes required by the Access Rule—and how states implement those changes—will have far reaching impact on state I/DD systems and the people they serve.

Join the Policy Information Exchange (PIE) for a discussion with state and provider experts who are thinking through their own approaches to Access Rule implementation. During the webinar, they will dive into the Access Rule’s impact on state I/DD programs, HCBS providers, and community partners, and individuals with I/DD and their families and caregivers. Specifically, they’ll discuss:

  • New and updated requirements related to HCBS incident management and grievance systems, payment adequacy and transparency, access and quality reporting and disclosure.
  • The implications for state I/DD systems—including challenges—as they plot a path to full implementation of the Access Rule within required timelines.
  • Strategies for building effective and collaborative engagement with community partners, people receiving services, providers, case management entities, and direct care workers.
  • Immediate steps that state I/DD systems should take now to assess their HCBS programs, processes, and IT infrastructure needs.

If you can’t make the live session on December 5, visit here to register for the free webinar now, and you’ll receive a link to view the program on demand.

More Details

Facilitators

Panelists

  • Pete Cervinka, Acting Director and Chief Deputy Director, California Department of Developmental Services (DDS)
  • Conor O’Dea, HCBS Policy Advisor, The Vermont Agency of Human Services
  • Lydia Dawson, Vice President of Government Relations, ANCOR

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On Friday, November 1, the Centers for Medicare & Medicaid Services (CMS) released an anticipated Final Rule titled “CY 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System Final Rule (CMS 1809-FC),” which includes three new exceptions for the federal “four walls” rule. At present, the “four walls” rule prohibits Medicaid payment for clinic services when both the practitioner and individual receiving service are outside of the “four walls” of the clinic unless the services are being provided to unhoused individuals (such as through street medicine). The new exception for Indian Health Services and Tribal Facilities is required nationally. The exceptions for Behavioral Health Clinics and Rural clinics are optional. States who determine that their Behavioral Health Clinic and/or Rural Health Clinic populations served meet the four criteria established by CMS (see page 1323 of the final rule) must submit a Medicaid State Plan Amendment (SPA) and receive approval from CMS for these exceptions to be in place for their state.

The Office of Mental Health and Substance Abuse Services (OMHSAS) had been working toward a short-term state level solution to the four walls issue for both Outpatient Psychiatric Clinics and Drug and Alcohol Clinics. However, now that a long-term federal option has been made available, the team in OMHSAS will be pivoting to pursue this newly available federal exception for Behavioral Health Clinics. While OMHSAS is still in the process of developing a timeline for the new State Plan Amendment, their team will be working on this as a top priority, with the goal of having a SPA in place in early 2025.

It has been confirmed that OMHSAS will not be shifting their current enforcement policy around the four walls while they work through getting this waiver in place. RCPA will continue its collaboration with OMHSAS on the process as this move forwards. If you have any questions, please contact RCPA COO and Mental Health Policy Director Jim Sharp.

For additional information, please see the following:

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