Capitol Correspondence - 07.15.19

Big Changes in Medicaid Access Rule, Home Health and New Quality Measures Roadmap Could Set Precedent for I/DD Supports

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ANCOR is sharing the three news items below because they show comprehensive changes coming to Medicaid and Medicare and the values driving health policy discussions in Washington DC. While the policies discussed below do not directly impact Medicaid programs that support people with intellectual / developmental disabilities (I/DD), they set important precedent that could come into play for I/DD supports in the future.

Proposal to Rescind the Medicaid Access Rule: As written by Modern Healthcare, “[The Centers for Medicare and Medicaid Services] CMS wants to lower states’ requirements for showing that their Medicaid fee-for-service payment rates are adequate to enlist enough providers to offer beneficiaries satisfactory access to care.

The rule proposed Thursday would rescind a 2015 Obama administration rule requiring states to file an access monitoring review plan and update it at least every three years.

The CMS said the proposed rule would save states money, and that it would issue a separate guidance reminding them that they must ensure beneficiaries have adequate access to care. The public will have 60 days to comment.


But other Medicaid experts warned that dropping the reporting requirements would make it more difficult to determine whether there are an adequate number of physicians and other providers available to serve patients in both the Medicaid fee-for-service and managed-care programs.”


2020 Home Health Payment Rule Reflects Administration’s Value-Based Approach: As shared by Politico Pro: “[CMS] on Thursday released a 2020 home health payment rule that further outlines a new methodology more keyed to value and that Congress mandated in 2018 as part of a bipartisan budget deal. Home health agencies worried that CMS would cut payments based on assumptions of how providers will change their behavior under the new system.

Medicare payments under the newly issued rule would increase in 2020 by 1.3 percent, or $250 million. The new rule also includes proposals aimed at establishing a permanent home infusion therapy benefit for 2021, as the 21st Century Cures Act required.

Instead of paying for the volume of therapy sessions, CMS will pay providers based on their patients’ clinical characteristics. The new system will be based on a 30-day episode of care, half the previous benchmark of 60 days.

CMS first developed the new payment system, called the Patient-Driven Groupings Model, last year, and it’s set to take effect Jan. 1. The 2020 payment rule includes a behavior adjustment cut at about 8 percent the base rate in the Patient-Driven Groupings Model, anticipating that some providers will change their coding and diagnosis practices to game the new system.”


HHS Announces Summit to Streamline Healthcare Quality Programs: As shared by Healthcare IT News, “Deputy Secretary Eric Hargan announced the summit this week and is seeking to cast a wide net for attendees from all corners of the industry – HHS is accepting nominations for participants for the rest of this month.

HHS quality programs – administered by the Centers for Medicare and Medicaid Services, Agency for Healthcare Research and Quality, the Centers for Disease Control, Health Resources and Services Administration, Indian Health Service and others – have often evolved over the past two decades, gaining more and more additional measures as they do.

But there hasn’t been a ‘systemic objective external review’ of their requirements and implementation since they were created, according to the department. So with the Quality Summit, HHS seeks to review them all to make sure their optimally serving its goals of quality improvement and value-based care.

The Summit will be chaired by Hargan and patient safety expert Dr. Peter Pronovost, chief clinical transformation officer at University Hospitals.”