ARLINGTON, Va. -- The Trump administration is doing its best to relieve the administrative burden for Medicaid plans, Brian Neale, director of the Center for Medicaid and CHIP Services, said here Wednesday.
"Medicaid directors say they are devoting way too much time responding to CMS [Centers for Medicare & Medicaid Services-]required tasks," Neale said at the annual meeting of the National Association of Medicaid Directors. "We're going to help them free up those resources. ... At CMS, we've heard from states that our business processes at CMS can be administratively cumbersome. We are often told [that we] ask too many unnecessary questions and that our response times [are too long]."
"We're addressing those concerns," and with good reason, he said. "Relieving some of the day-to-day administrative burden of states means spending less time checking boxes and more time developing approaches that improve health outcomes."
Two information bulletins that CMS released this week -- one on state Medicaid plan amendments and 1915 waivers, and the other on 1115 Medicaid demonstration projects -- "outline the agency's progress," Neale continued. On the plan amendments and 1915 waiver side, "we have created simpler, more user-friendly templates for states to use ... which will streamline the approval process all around. On the [1115] demonstration side, we have adjusted standards so more states can take advantage of the existing fast-track waiver process, providing an easier road to renewal."
"This all comes as a direct result of our ongoing dialogue with Medicaid directors. The work we've put into this effort together will certainly pay dividends over the years ahead."
CMS also is working to make things easier for Medicaid managed care plans, Neale noted. "We all recognize the need for a basic regulatory structure around Medicaid managed care, but we all agree that the structure needs to be fair and practical. Our primary thrust is lessening the states' administrative burden."
"We will be keeping our sleeves rolled up," he said, adding that a Notice of Proposed Rulemaking in this area "should hit the streets next year."
Rate review is another area of focus for the agency, Neale said. "So far this year, 84% of rate submissions were approved within 90 days; in 2015, that number was 4%," he said. "We recently sent an invitation to states to help us test a new, expedited process for rate review. ... We hope the lessons learned will further streamline rate reviews."
CMS also announced a new 1115 waiver opportunity related to the opioid crisis, he said. "We recognize that importance of a strong continuum of care [for these patients], and we know treatment in residential settings, including IMDs [institutions for mental diseases] could be an important part of that continuum."
Under current rules, Medicaid usually doesn't pay for treatment in IMDs -- defined as a hospital nursing facility or other institution greater than 16 beds that is engaged in providing diagnosis, treatment, or care of persons with mental diseases -- for adults younger than 64. Although a previous [waiver] attempted to ease that rule somewhat, it "required an ideal delivery system buildout as a condition and precedent to allowing IMD [payments]," Neale said.
"Our new demonstration opportunity meets states where they are, allowing payments to come sooner while establishing milestones over the course of the demonstration for achieving a better delivery system for substance use disorder treatment ... and enhanced metrics which will help us learn faster what's working and what's not as we continue to fight this epidemic."
He noted that Congress has asked CMS to take a look at the 1115 waiver process. "There are many interested in what can be done on the administrative side" to streamline the waivers, but added that such legislation "comes with a price tag. ... It's really important to understand what the costs are, and what's needed as well; we can't waive a budget neutrality wand and deem it sound."