Staying or Going: Update on CMS Initiatives and Staffing in Final Days of Trump Administration

The Centers for Medicare and Medicaid Services (CMS) withdrew, finalized or issued guidance for four initiatives relevant to the disability space, and took steps to  secure changes made during the Trump administration. Each of these are detailed below. Note that some of these changes will be made as a leadership vacuum develops in the agency, with acting CMS Chief of Staff Calder Lynch exiting the administration and new political appointees for the incoming Biden administration not yet nominated.

• Withdrawn: Proposed Medicaid Fiscal Accountability Rule (MFAR). In a victory for ANCOR members, CMS Administrator Seema Verma tweeted on Thursday: “Today I took action to withdraw the proposed Medicaid Fiscal Accountability Rule (MFAR) from the federal register. While we support its intent, further work is needed to ensure accountability for states while protecting critical safety-net care for vulnerable patients.” ANCOR had opposed the proposal because of its potential effect on Medicaid budgets overall.

• Approved: Tennessee Medicaid block grant. As reported by Politico Pro: “The Trump administration has approved Tennessee’s request for the nation’s first Medicaid block grant, a long-sought conservative overhaul fundamentally restructuring the safety net health program. Finalizing the Tennessee plan has been a priority for Medicare and Medicaid Chief Seema Verma in the Trump administration’s final weeks, but Friday’s approval could tee up a legal challenge from Medicaid advocates who fear a block grant would result in cutbacks to health coverage for the most vulnerable. President-elect Joe Biden, who has promised to expand the health-care safety net, could also look to roll back the approval upon taking office.”

• Issued: Guidance on using social determinants of health in Medicaid. As announced by CMS: “The Centers for Medicare & Medicaid Services (CMS) issued guidance to state health officials designed to drive the adoption of strategies that address the social determinants of health (SDOH) in Medicaid and the Children’s Health Insurance Program (CHIP) so states can further improve beneficiary health outcomes, reduce health disparities, and lower overall costs in Medicaid and CHIP.”

• Issued: Guidance on Medicaid managed care state directed payments. The guidance clarifies for states “the standards and documentation for Medicaid managed care state directed payments, which will reduce state administrative burden, enhance federal oversight of Medicaid managed care, and improve fiscal and program integrity. This guidance also offers additional information on the types of contractual payment requirements that are considered state directed payments, standards for reimbursement analyses, requirements for incorporating state directed payments into rate certifications, and ties to the quality strategy.”

• Pending: CMS asks states to sign agreement locking in changes to Medicaid. As reported by Politico Pro: “CMS Administrator Seema Verma is asking states to sign an agreement ‘as soon as possible’ to lock in a lengthy process if her agency decides to terminate, amend or withdraw a state’s Medicaid experiment in the future, according to communications reviewed by POLITICO. The letter is viewed as an attempt to make it harder to erase controversial policies approved by the Trump administration, according to multiple Medicaid advocates. […] ‘Your terms and conditions describe this process at only a high level, without describing the advance notice or the specific timeline in which such an opportunity to be heard would occur,’ Verma wrote to states this month. The letter detailed various timelines for submitting paperwork and holding a hearing, and notes CMS will give states at least nine months before a Medicaid project must end. Edwin Park, a research professor at the Georgetown University McCourt School of Public Policy, confirmed the move deviates from how Medicaid waivers are typically structured.”