On February 16, the Senate Finance Committee will hold a hearing on the nomination of Seema Verma to be Administrator of the Centers for Medicare and Medicaid Services (CMS). CMS oversees both Medicare and Medicaid. Medicare is a health insurance program for Social Security beneficiaries. Medicaid is a joint state-federal health insurance program for low-income individuals. Both programs serve people with disabilities. In addition to medical care, Medicaid also covers long term supports and services such as residential support, personal assistance, respite care, supported living, assistive technology, and supported employment. Visit the Committee web site for more information or to access live video the day of the hearing.
On September 9, 2016, the Government Accountability Office released areport on the policy considerations of Medicaid per capita spending caps at the request of the Senate Finance Committee leadership. The report outlines important details to be considered in drafting future legislation including coverage and flexibility, allocation of funds across states and over time, accountability, and broader effects.
On Monday, April 25, HHS released an advanced notice of a final rule revising Medicaid managed care regulations. The managed care rules were last updated in 2002. The intent of the re-write was to more closely align the Medicaid managed care rules with the rules governing other health insurance programs. The final rules included changes in the appeals process, the quality system, network adequacy, and a number of other changes. Many of the provisions of the rule will take effect 60 days after publication though some provisions are effective at a later date. The Arc will be reviewing the regulations and will provide additional analysis.
Last week, The Centers for Medicare & Medicaid Services (CMS) released its 2016 Medicaid Managed Care Rate Development Guide. This document will assist states in developing their Medicaid managed care rates for periods beginning on or after January 1, 2016. States and their actuaries are encouraged to follow this guide in the development of their actuarial certifications. After states submit their proposals, CMS will use this Guide as well as the regulations found at 42 CFR 438.6 as the basis for the review of 2016 actuarial certifications. If you have any questions about the guide, please send them to MMCratesetting@cms.hhs.gov.
On July 29, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a final decision memorandum related to coverage of speech generating devices. These devices fall within the Medicare durable medical equipment (DME) benefit category. The memorandum was issued to address significant advances in technology since 2001, when the previous benefit coverage determination was issued. Fortunately, CMS determined that devices that generate speech will still be considered DME even though they can perform other functions (such as email and text messages), as long as they are “used solely by the patient with the severe speech impairment and are used primarily for the generation of speech.” Unfortunately, however, the memorandum excludes coverage for computers, tablets, and similar devices used in conjunction with speech generating applications as they “are not primarily used for a medical purpose and are useful in the absence of an illness or injury and therefore, do not meet the definition of DME.” Disability advocates had sought coverage of computers, tablets, and similar devices because they are less expensive and easier to use than many speech generating devices. Read the memorandum here.
Last week, the Centers for Medicare & Medicaid Services (CMS) released the 2013 Medicaid Expenditures for Long-Term Services and Supports Report. This report documents progress the Medicaid program has made to promote community living for older adults and people with disabilities. CMS and Truven Health will host a webinar to discuss the report findings Friday, July 31, from 3 – 4 p.m. (EDT). To register, click here.
Last week, the Centers for Medicare & Medicaid Services (CMS) released Frequently Asked Questions (FAQs) related to Home and Community-Based Services (HCBS) Settings Rule. The guidance focuses on the process for states to use in overcoming the presumption that certain settings have the characteristics of an institution, and highlights the heightened scrutiny review that CMS will give such information submitted from states.
Last week, Senator Chuck Grassley (R-IA), together with Senator Ron Wyden (D-OR) and Senator Bob Casey (D-PA), introduced S. 1604, Transition to Independence Medicaid Buy-In Option, bipartisan legislation which would, as stated in Sen. Grassley’s press release, “create a demonstration project to encourage states to improve opportunities for individuals with disabilities to obtain employment in the community, gaining self-determination, independence, productivity, and integration and inclusion.” Ten states, over a period of five years, would receive bonus payments for meeting benchmarks which are outlined in the bill’s technical summary.
Last week, the Centers for Medicare & Medicaid Services (CMS) released a notice of proposed rulemaking toward modernization of the Medicaid and Children’s Health Insurance Program (CHIP) managed care regulations and to update the programs’ rules and strengthen beneficiary services. For more information, including summaries of key provisions of the proposed rule, visit medicaid.gov. Staff from The Arc will be reviewing the regulations and providing comments. The deadline to submit comments is July 27, 2015.
Medicaid, Social Security Disability Insurance (SSDI), and other lifeline programs for people with I/DD are under attack. The House and Senate passed a concurrent budget resolution that calls for significant cuts, setting in motion a process to restructure the Medicaid program. It’s time to act! We are calling on our advocates to engage their Members of Congress in support of these critical programs. Please register your concerns by responding to the action alert posted above. To assist you with engaging in other activities, The Arc has created a toolkit with tips and key messages to convey. The Memorial Day recess and the July 4th recess are excellent times to step up our activities by writing, calling or visiting your Member of Congress.