The Centers for Medicare and Medicaid Services is strengthening its focus and has recently taken several steps to make state Medicaid programs stronger, increase oversight of Medicaid Advantage plans, and promote promote health equity efforts.
Jonathan Blum, the agency’s principal deputy administrator and chief executive officer, discussed these priorities with Modern Healthcare while he was in Chicago this week for the Information and Management Systems Association conference. Health in 2023.
Here are the things to know.
Redefining strengthens Medicaid
Blum said that states pausing removing individuals from Medicaid during the COVID-19 pandemic in exchange for increased federal funding would make the public benefit program more robust. States have invested in technology and refined their existing eligibility systems, as they resume eligibility checks for the first time in two and a half years.
“This process has forced countries to build better structures that will last much longer than this process,” he said. “Eligibility processes are always a big challenge for countries. We’ll have stronger Medicaid programs once they’re done.”
At the federal level, CMS has tweaked Healthcare.gov to automatically populate users’ information from their Medicaid files into an exchange application. By better connecting technology systems between Medicaid and the exchange programs, Blum said he hopes to close the gap in consumer coverage.
States should follow Illinois’ lead
Blum said more states should follow Illinois’ lead and pursue amendments that would allow public schools to bill for Medicaid medical services.
CMS this week approved an amendment to the state plan to provide more Medicaid funds to Illinois to pay for behavioral health, physical therapy, preventive care and other medical services for all students. students enrolled in Medicaid or the Children’s Health Insurance Program, not just students with an Individualized Education Program. CMS has granted similar modifications to 11 other states’ Medicaid programs.
Blum said the state plan revision also strengthens the relationship between the Medicaid program and schools as redeterminations continue.
“Schools have much more accurate addresses and location data than insurance companies,” he said. “It will help with other policy goals we have. It is a really great development.”
CMS ready to crack down with ‘corrective action’
CMS will also monitor exceptions between states that process Medicaid-eligible applications too quickly or slowly, as well as in places where large numbers of individuals are not eligible for other coverage, where people Consumers report long call center wait times and more. In those cases, Blum said the agency can and will suspend states’ ability to remove individuals from Medicaid until they refine their processes.
“Our teams are ready and willing to use that authority if necessary,” he said.
More surveillance is coming
One of CMS’s primary goals is to tailor plan integrity processes to reflect the reality that the majority of individuals sign up for managed care arrangements, either through Medicaid or Medicare Advantage plans. . “Our oversight needs to move to managed care where we have previously done it through a traditional fee-for-service system,” Blum said.
That is the view that led CMS to finalize the Medicare Advantage risk-adjusted data validation rule, which allows the agency to recover past overpayments to insurers. It’s also what prompted CMS to improve its Medicare Advantage risk-adjusted program, although the changes will be made in phases over three years.
“We disagree,” Blum said, responding to criticism that CMS’s eventual Medicare Advantage rules don’t go far enough in limiting insurers’ excessive profits. “But we also understand that changes need to be carefully calibrated for plans to accommodate, so we don’t disrupt premiums and cut benefits quickly.”
Revamped star rating will enhance health equity
CMS has retooled its Medicare Advantage star rating program to incentivize insurers to close the health equity gap. The agency has removed the “reward factor” that gives insurers greater rewards if they’ve consistently performed well over time. Instead, CMS this month finalized a plan to establish a health equity index to incentivize plans to build better service access in healthcare desert regions, and offer policies in disadvantaged areas in an effort to improve people’s health.
“I would challenge anyone to provide clear evidence that enrolling more in managed care organizations, enrolling more in a Medicare Advantage plan, results in more savings,” Blum said. better outcomes and better quality of care,” Blum said. “It can happen at the individual level, but I would challenge anyone to provide solid evidence that it happens at the population level.”
