Scoring rural health
CMS developed a 23-factor scoring methodology to allocate $25 billion in workload funding through the $50 billion Rural Health Transformation Program.
The Centers for Medicare and Medicaid Services (CMS) released a notice of funding opportunity this week, which included considerable detail on how the agency will administer $25 billion in workload funding to states. The 23 factors stretch across current state policies on Supplemental Nutrition Assistance Program, telehealth, scope of practice and certificate of need programs to a state’s total square miles. Notably, CMS intends to tie the distribution of workload funding in years two through five to each state’s program performance on CMS’ score factors, creating additional uncertainty in a state’s funding allocations (given that the amount awarded from the $25 billion workload funding pool may fluctuate annually).
CMS Acts on Medicaid State-Directed Payments
The Centers for Medicare and Medicaid Services (CMS) released preliminary guidance on the implementation of state-directed payment (SDP) limits under H.R.1 (P.L. 119-21) on Sept. 9. The agency also approved a number of new state SDP preprints last week.
As explained in previous 80 Million blogs, H.R.1 limits the total payment rate of any new SDPs to 100% of Medicare rates for expansion states and 110% of Medicare rates for non-expansion states, but temporarily “grandfathers” certain SDPs with higher payment levels. Beginning in 2028, states must reduce these grandfathered SDPs by 10 percentage points per year until the total payment rate equals 100% of Medicare for expansion states and 110% for non-expansion states. These limitations, together with new restrictions on state use of provider taxes in expansion states, are estimated to result in substantial Medicaid funding cuts to states these cuts impact all states but have disproportionate effect on Medicaid expansion states.
In its new guidance, CMS clarified the definition and payment limits for grandfathered SDPs. Notably, CMS sets a more stringent limit on grandfathered SDPs by basing the cap on an aggregate dollar cap included in the approved preprint rather than setting a per-service cap. CMS characterizes the guidance as preliminary and notes that it intends to engage in formal rulemaking on SDPs soon, and its formal rulemaking may impose payment limits on additional services not subject to the SDP limits in H.R.1.
Here are the specifics of the key grandfathering issues addressed in the guidance.
Keep reading at The 80 Million.
ICYMI: Too Poor for Affordable Health Insurance: CBO Breaks Down H.R.1 Marketplace Coverage Loss Impacts and Fraud Claims
The Congressional Budget Office (CBO) released the numbers underpinning its projection that 2.1 million individuals will go uninsured due to H.R.1’s Affordable Care Act (ACA) Marketplace provisions. About half of that coverage loss is the result of eliminating premium tax credit (PTC) eligibility for some categories of lawfully present noncitizens, and the other half is from making it more difficult for individuals to sign up for and maintain Marketplace coverage.
These losses are on top of CBO’s estimate that 4.2 million people will go uninsured if Congress does not act to extend Marketplace enhanced premium tax credits (ePTC) and that another 1.9 million will lose coverage through the implementation of CMS’ Marketplace Integrity and Affordability final rule. Together, that could raise the number of newly uninsured people by as many as 8 million.
In the report, CBO analyzes potential incidences of enrollment fraud and estimates that 2.3 million people earning less than 100% of the FPL ($15,060 for the 2025 PTC calculation) inappropriately projected their income to be above 100% of the FPL.
However, CBO gives short shrift to the fact that income projection is a feature of the ACA’s advance PTC and that income clairvoyance is an impossibility, particularly for individuals with low and unpredictable income.
Keep reading at The 80 Million.
Alabama’s Medicaid agency issued a 30-day public review and comment period for a proposed amendment to its community waiver program. The proposal would update the program’s eligibility to allow relatives to receive payment for personal care and transportation services.
Colorado Gov. Jared Polis and Lt. Gov. Dianne Primavera sent a letter to the state’s Congressional delegation calling on them to extend the enhanced premium tax credits (ePTCs) by the end of September.
Connecticut Gov. Ned Lamont announced the establishment of the Connecticut Office of the Behavioral Health Advocate, a new independent state office statutorily assigned to assist residents with accessing mental health and behavioral health care resources, supporting behavioral health providers with receiving timely payments and advocating for greater access, with the overarching goal of improving consumer outcomes.
New York’s health department announced that the state is taking action to preserve access to health care following cuts in federal funding from H.R.1, which eliminates $7.5 billion in annual funding for the Essential Plan. The state is proposing to end its 1332 State Innovation Waiver and return to a Basic Health Program. This action would allow an estimated 1.3 million New Yorkers to remain enrolled in the program and mitigate revenue losses to the health care delivery system.
Medicaid cuts coming Oct. 1. NC health groups urge state leader to halt them – The News & Observer
How Medicaid cuts will hurt every hospital — including yours – WBUR
Inside the hospital ‘war rooms’ bracing for Medicaid cuts – Stat News
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