AIS Health – March 30, 2020 edition of Health Plan Weekly

Jeff Myers, Senior Vice President of Reimbursement Strategy and Market Access at Catalyst Healthcare Consulting weighs in on the CMS Medicaid Section 1135 waivers provided to states during this COVID-19 public health emergency as an effort to improve COVID-19 responses. Read the full article reprinted with permission from AISHealth.com below:

CMS has now approved 29 Medicaid Section 1135 waivers in an effort to give states’ Medicaid programs additional flexibility to augment their COVID-19 response by relaxing certain federal requirements.

Observers say they anticipate more states approaching CMS with similar requests as the crisis progresses, although the waivers may not streamline care very much for managed care organizations operating within state Medicaid programs.

Jeff Myers, senior vice president of reimbursement strategy and market access at Catalyst Healthcare Consulting, says some of the waivers address “things the plans are trying to do anyway,” such as fixing the provider enrollment process. The true impact on plan operation may not be large, Myers tells AIS Health.

Section 1135 waivers are available during disasters or emergencies and allow CMS to temporarily waive or modify certain Medicare, Medicaid and CHIP requirements to ensure that access to care doesn’t fall off.

WAIVERS LET STATES SKIP SOME MANDATES

The newly approved 1135 waivers provide relief for states and MCOs on a number of fronts, such as prior authorization and provider enrollment requirements. They also suspend certain nursing home pre-admission reviews and facilitate reimbursement to providers for care delivered in alternative settings due to facility evacuations. Finally, they relax public notice and submission deadlines for certain COVID-19-focused Medicaid state plan amendments, enabling states to make changes faster and ensuring they can be retroactive to the beginning of the emergency.

Section 1135 waivers initially were approved in mid-March for Florida and Washington. By March 27, that number had risen to 29, with CMS approving waivers “within days of states’ submitting them,” the agency noted. Since each state submits its own individual waiver, not all provisions appear in all approved waivers.

The Section 1135 waivers are effective March 1, 2020, and will end upon termination of the public health emergency, including any extensions.

‘THESE ARE EXTRAORDINARY TIMES’

Jerry Vitti, founder and CEO of Healthcare Financial, Inc., a Boston-area company that connects low-income, elderly and disabled populations with public benefit programs, says the waivers’ approval “underscores the fact that this population is more vulnerable than other populations.” He tells AIS Health: “Clearly these are extraordinary times, and states and plans need flexibility.”

Tucked into the waivers are provisions that will make it easier for MCOs to use out-of-state providers or retired clinicians, Vitti says, adding, “this should make it easier for folks to re- enter the workforce” in states with that specific waiver provision.

“I have to give folks credit in the federal government for their quick response to this,” Vitti says. “Every state should be trying to get more coverage and more flexibility. This underscores the complexity of the population and the barriers people face.”

Many states don’t have broad access to COVID-19 testing yet, but once they do, Vitti says he anticipates more waiver requests. “Once they have the testing and they get an understanding of the scope of this, then you’ll see the rapid requesting of these waivers,” he says. “Stability of coverage should be first and foremost — that, and removing administrative barriers.”

States asked for different things in their waiver requests, with varying impacts on MCOs operating within those states’ Medicaid programs. For example, California and several other states got permission to temporarily enroll providers who are enrolled with other state Medicaid agencies or Medicare. California, New Jersey and North Carolina also received permission to reimburse services rendered to an unlicensed facility during an emergency evacuation if the facility meets minimum standards. This would allow services to be provided in temporary hospitals and other facilities, which some states are setting up in order to treat surges of COVID-19 patients.

Alabama, along with other states, asked CMS to suspend pre-admission screening and annual resident review level 1 and level 2 assessments for 30 days for nursing facilities. And multiple states, including Virginia and New Mexico, got permission to temporarily suspend Medicaid fee-for-service prior authorization requirements.

States might want to consider mirroring within their Medicaid programs the Section 1135 waiver CMS issued on March 17 to broaden access to Medicare telehealth services, Myers says. That waiver reduces the amount of paperwork that Medicare plans need to complete before taking telehealth services live. The approach has the potential to help some Medicaid plans, as well, Myers suggests. Still, he notes, many in the Medicaid population lack broadband services, so telehealth may not be as useful in that population.

In other Medicaid-related news, CMS withdrew its proposed Medicaid Fiscal Accountability Regulation, which would have changed the way states are reimbursed for Medicaid payments to providers. America’s Health Insurance Plans had objected to the rule, arguing that it would hamper states from being able to fully fund their Medicaid programs (HPW 2/10/20, p. 7).

Read the CMS news release at https://go.cms.gov/2QOIaRI. Contact Myers and Vitti via Joe Reblando at joe@joereblando.com.