The Centers of Medicare and Medicaid Services (CMS) revealed on August 16th, 2018 changes to the Medicaid Review Process, unveiling substantial reduction in approval times. The new updates will generate faster processing of state requests to streamline changes to their Medicaid program through the state plan amendment and section 1915 waiver review process. Less than 1 week following this move, CMS announced $8.6 million in funding to 30 states and the District of Columbia to help reinforce and stabilize corresponding health insurance markets under the Affordable Care Act (ACA).
“With faster processing times and earlier communication, states now have much greater ability to manage their programs in an effective and predictable manner,” said CMS Administrator Seema Verma. “We want to ease bureaucratic requirements for both states and our own staff so that we can focus those resources on improving health outcomes rather than pushing paperwork.”
States must obtain CMS approval for any suggestions or variations they would like to make to their Medicaid programs (made through a State Plan Amendment: SPA) or section 1915 waiver), even for minor changes. In alliance with CMS and individual states, CMS has improved the review process for SPAs. According to Healthcare Finance News, results show: 23 percent decrease in the median approval time for Medicaid SPAs between 2016 and first quarter 2018, 84 percent of Medicaid SPAs were approved within the first 90-day review period in first quarter of 2018, a 20 percent increase over calendar year 2016; a 7 percent decrease in median approval times for HCBS waivers; a 38 percent decrease in HCBS renewal approval times; and amendment approval times dropped 44 percent for long-term care services.
“These grants build on CMS’s ongoing efforts to give states the tools and flexibility they need to help people struggling to afford the year-over-year premium increases caused by Obamacare regulations,” said Verma. The granted $8.6 million encompasses unspent rate review funding from earlier years, available to be awarded with intention of planning and executing federal insurance reforms. Fortunately, certain states are not demanding funding from CMS or are coming in under budget for their rate review grant projects.
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