CMS Release First CURES-Related Medicaid Update

A State Operational Technical Advisory call discussed tool for comparing Medicare and Medicaid rates and explained reporting process.

CMS recently hosted a State Operational Technical Advisory (SOTA) call in which it provided an update on implementation of Medicaid-related provisions the CURES Act, according to the American Association for Homecare, which participated in the call.

Passed in December of 2016, the CURES Act CURES Act included provisions to give relief to providers and patients affected by the national expansion of competitive bidding to non-bid areas.

However, the Act also included an acceleration of the plan to limit the Federal matching on Medicaid reimbursement rates for HME to the Medicare fee-for-service payment rates, including for items impacted by competitive bidding-derived rates. Rather than apply those rates in January 2019, the application would be ramped up by one year to Jan. 1, 2018. 

The recent SOTA call reinforce to the state Medicaid program representatives listening that the CURES provisions were limited to primary Medicaid fee for service claims and do not include Medicaid managed care claims or secondary claims.

CMS introduced a tool for reconciling information reported by the states and for comparing the state Medicaid rates with the Medicare rates. Using the tool, state Medicaid programs can include the area where a patient lives and Medicare will reconcile this to the Medicare allowable for that area. If location is left blank on a form, CMS will reconcile to the lowest Medicare allowable in the state.

The agency also outlined the reporting process state Medicaid programs must follow, and underscored that the states’ reporting must be completed by March 30, 2019. 

CMS reiterated that states can pay whatever they deem necessary to avoid impacting patient access, and that CURES only impacts the Federal Financial Match portion.

“It is important to note that CMS will be basing their reconciliations on the aggregate Medicaid spend vs. what the aggregate Medicare spend would have been for all products on this HCPCS list that have been furnished,” a statement from AAHomecare read.

Where it comes to states implementing the rates, AAHomecare noted that CMS has yet to release a letter to state Medicaid directors that includes the HCPCS list, but the association stated it had received a preliminary copy of what will be included in the reconciliation from CMS. Providers can download that preliminary lists at  http://bit.ly/2zecyNi. The association emphasized that the list is preliminary and could change prior to final publication. 

In terms of specific states’ intentions, AAHomecare noted that Washington and Indiana indicated they intended to move to Medicare, and other states have contacted state HME associations and AAHomecare to say they intended to do the same.

“AAHomecare is currently partnering with state associations to analyze their data, educate their State Medicaid programs, and come up with a solution that will best serve patients, providers and the state Medicaid program,” the association’s statement read. “We have also engaged outside counsel to make sure we are providing legally-sound guidance.”

About the Author

David Kopf is the Editor of HME Business.

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