\n \n $\"Medicaid$ \n<\/picture>\n<\/a>
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\nCenters for Medicare and Medicaid Services\n<\/p>\n

CMS Principal Deputy Administrator and Chief Operating Officer Jonathan Blum.<\/p>\n<\/div>\n<\/div>\n

The Centers for Medicare and Medicaid Services is sharpening its focus, and has recently taken several steps to make state Medicaid programs stronger, increase its oversight of Medicaid Advantage programs and boost health equity efforts.<\/p>\n

Jonathan Blum, the agency’s principal deputy administrator and chief operating officer,\u00a0discussed these priorities with\u00a0Modern Healthcare while he was in Chicago this week for the 2023 Healthcare Information and Management Systems Society conference.\u00a0<\/p>\n

Here’s what to know.\u00a0<\/p>\n

Redeterminations will strengthen Medicaid<\/h2>\n
The pause by states on removing individuals from Medicaid during the COVID-19 pandemic in exchange for increased federal funding will make the public benefits program stronger, Blum said. States have invested in\u00a0 technology and fine-tuned their existing eligibility systems, as they resume eligibility checks <\/a>for the first time in two-and-a-half years.\u00a0<\/p>\n
\u201cThe process has forced states to build better structures that will last much longer than this process,\u201d he said. \u201cEligibility processes have always been a huge challenge for states. We will have stronger Medicaid programs once we finish.\u201d \u00a0<\/p>\n
At the federal level, CMS fine-tuned Healthcare.gov to automatically populate a user\u2019s information from their Medicaid file to an exchange application. By better connecting technology systems between Medicaid and exchange plans, Blum said he hopes to avoid consumer gaps in coverage. \u00a0<\/p>\n

States should follow Illinois’ lead<\/h2>\n
More states should follow Illinois\u2019 lead and pursue amendments that allow public schools to bill Medicaid for health services, Blum said.\u00a0<\/p>\n
CMS this week approved a state plan amendment to award Illinois additional Medicaid funding to\u00a0pay for behavioral health, physical therapy, preventative care and other health services for all students enrolled in Medicaid or the Children’s Health Insurance Program, not just those with an Individualized Education Program.\u00a0CMS has granted similar amendments to 11 other states’ Medicaid programs.\u00a0<\/p>\n
The state plan amendment also strengthens ties between the Medicaid program and schools as redeterminations resume, Blum said.\u00a0<\/p>\n
\u201cSchools have much more accurate address, location data than insurance companies,\u201d he said. \u201cIt will help with other policy goals we have. It\u2019s a really cool development.\u201d \u00a0<\/p>\n
CMS is ready to crack down with \u2018corrective action\u2019\u00a0<\/h2>\n
CMS will also be watching for outliers among states that process Medicaid eligibility applications too quickly or slowly, as well as where there are large number\u00a0of individuals who do not qualify for other coverage, where consumers report long call center wait times and more.\u00a0In those cases,<\/strong> the\u00a0agency can, and will, pause states\u2019 ability to remove individuals from Medicaid until they refine their processes, Blum said.\u00a0<\/p>\n
\u201cOur teams are poised and ready to use that authority if necessary,\u201d he said. \u00a0<\/p>\n
More oversight is coming<\/h2>\n
One of CMS\u2019 primary goals is to tinker with its program integrity processes to reflect the reality that the majority of individuals are enrolled in managed care arrangements, either through Medicaid or Medicare Advantage plans. \u201cOur oversight needs to be shifting towards managed care when historically we\u2019ve been doing that through a traditional, fee-for-service system,\u201d Blum said. \u00a0<\/p>\n
That\u2019s the perspective that led CMS to finalize the Medicare Advantage risk-adjustment data validation rule<\/a>, which allows the agency to recoup previous overpayments to insurers. It’s what also led CMS to revamp its Medicare Advantage <\/a>risk-adjustment program, although the changes will be phased in over three years.<\/p>\n
\u201cWe don\u2019t disagree,\u201d Blum said, in response to criticism that CMS\u2019 final Medicare Advantage rules do not go far enough in curbing\u00a0insurers’ excessive profits.\u00a0 \u201cBut we also understand changes need to be carefully calibrated so plans can adjust, so we don\u2019t disrupt premiums and cut benefits rapidly.\u201d\u00a0<\/p>\n
Revamped star ratings will boost health equity<\/h2>\n
CMS retooled the Medicare Advantage star ratings program <\/a>to incentivize insurers to bridge health equity gaps. The agency removed the \u201creward factor\u201d that gave insurers a bigger bonus if they consistently performed well over time. In its place, CMS this\u00a0month finalized a plan<\/a> to establish a health equity index to incentivize plans to build better access to services in healthcare deserts, and offer policies in disadvantaged areas in an effort to improve population health.\u00a0<\/p>\n
\u201cI would challenge anybody to provide definitive evidence that more enrollment in managed care organizations, more enrollment in the Medicare Advantage program, drives better savings, better outcomes and better quality of care,\u201d Blum said. \u201cIt may happen at an individual level, but I would challenge anyone to provide definitive evidence it happens at the full, population level.\u201d\u00a0<\/p>\n
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Skip to main content Centers for Medicare and Medicaid Services CMS Principal Deputy Administrator and Chief Operating Officer Jonathan Blum. The Centers for Medicare and Medicaid Services is sharpening its focus, and has recently taken several steps to make state Medicaid programs stronger, increase its oversight of Medicaid Advantage programs and boost health equity efforts.<\/p>\n","protected":false},"author":1,"featured_media":633283,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[121826,2087],"tags":[],"class_list":{"0":"post-633282","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-cms","8":"category-jonathan"},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/633282","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/comments?post=633282"}],"version-history":[{"count":0,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/posts\/633282\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media\/633283"}],"wp:attachment":[{"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/media?parent=633282"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/categories?post=633282"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/newsycanuse.com\/index.php\/wp-json\/wp\/v2\/tags?post=633282"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}