CMS eases pressure on states, AAH says

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Friday, January 5, 2018

WASHINGTON – CMS has given state Medicaid directors more “open-ended guidance” for complying with a provision in the 21st Century Cures Act, AAHomecare reported Jan. 5.

In a Jan. 4 letter, CMS states: "States electing to submit an aggregate payment comparison, or an alternative approach to compliance as mentioned earlier in this letter, will work with CMS to determine the best approach to calculate the FFP limit for their state using expenditures for the period of January 1, 2018, through December 31, 2018."

The letter continues: “CMS is in the process of obtaining the required Office of Management and Budget (OMB) approval for these payment comparisons via the Paperwork Reduction Act (PRA) process. Only after CMS obtains a valid OMB control number will states be required to submit this information. Assuming PRA approval, the first comparative analysis must be submitted to CMS by March 31, 2019.”

In a Dec. 27 letter, CMS stated that states choosing this option must inform the agency by Dec. 31, 2017, giving them less than three business days to make a decision.

The previous letter outlined two options for states to demonstrate compliance with the provision: base Medicaid reimbursement on Medicare’s fee schedule or competitive bid rates, or a lesser percentage thereof; or conduct a “robust comparison” using both rate and unit utilization data to calculate what would have been the aggregate reimbursement under Medicare for those same items to demonstrate that Medicaid reimbursement is less than the allowable amount.

If states choose the first option, they must submit a plan amendment no later than March 31, 2018, with an effective date no later than Jan. 1, 2018.

The provision requires CMS to cap its contribution to Medicaid reimbursement for certain DME at Medicare reimbursement.