CMS Official Addresses Outlook on Medicaid Home Care Policy at the March on Washington (Part 2 of 2)
April 15, 2016 09:02 AM
Melissa Harris, Senior Policy Advisor for the Disabled and Elderly Health Programs Group at the Center for Medicaid and CHIP Services, Centers for Medicare and Medicaid Services (CMS), spoke at the National Association for Home Care & Hospice’s (NAHC) 2016 March on Washington Conference regarding the outlook on Medicaid home care policy. For Part 1 of NAHC Report’s coverage of this session, please click here.
Ms. Harris addressed efforts by Medicaid to measure and ensure access to services for Medicaid beneficiaries. CMS released a Medicaid access monitoring regulation last year, she said, which requires states to do triennial access monitoring plans that CMS will then be reviewing to make sure states “are keeping an eye on access patternsand making sure that all of the necessary disciplines - between primary, acute and long-term care - are available to people.” She added that given the challenges to developing access measures for home and community-based services, CMS subsequently released a request for information. “We have every intention of continuing that conversation publicly as we are distilling some of the thoughts that we received in the form of public comment,” she said.
“The access reg is our firm intent to lay down federal benchmarks,” she continued, “and the triennial monitoring plan at least requires the states to be looking on a consistent basis and not waiting until it’s a crisis point. I think it is a great step forward. Whether or not it is the only thing that is necessary, I think, won’t reveal itself until we are a few years in.” William A. Dombi, Vice President for Law at NAHC, agreed that, from the provider perspective, the action is a “significant, positive step.”
Regarding the Medicaid face-to-face rule, Dombi asked Ms. Harris to address the extent to which the rule will reflect or differ from the Medicare face-to-face rule. “We did learn a lot of lessons from our Medicare colleagues,” she responded. “We did keep an eye on the fact that as time progressed they were loosening up a little bit on the documentation requirements of what the expectations were for physicians, or whoever was documenting the face-to-face, and what specific requirements needed to be in there.”
She acknowledged that the rule “will have fiscal implications” but argued that it will be a positive step forward for “community integration” and “alternatives to institutional services.” She also stated that, while the regulation will technically be effective in July 2016, there will be delayed implementation of the entire regulation for certain states based on their state legislative cycles. She said there will be a one or two year delay for certain states as a recognition of the fact that “there is a high likelihood that states will need to approach their legislatures for additional money to implement some of the DME provisions… If [the legislature meets] on an annual basis or a biannual basis or every two years, that will kind of drive the effective date of the regulation,” she said.
With the “wide variation” in available Medicaid home care benefits by state, Dombi asked Ms. Harris to speak to whether there might be steps Medicaid will take at the federal level to set “base minimum programs for home care in order comply with the ADA and Olmstead.” Ms. Harris responded, “To a large extent, I think the structure of the Medicaid program is such that there will always be 50 Medicaid programs.” She added, “It can be a heartbreaking conversation to have if someone is established receiving services in one state and, for any number of reasons, they need to relocate only to find that their needed services are not available to them.”
“I don’t see anything changing that reality unless there is some really broad, sweeping legislative change to the Medicaid program,” she said. “The good news is that because you have some states that are perpetually kind of out front pushing the envelope a little bit, there’s kind of laboratory in which to learn what works, what doesn’t, and allow some of the other states to go on a more direct path to implementing the promising practices. But it also requires the states to take the initiative to make the changes.”