As expected, the Centers for Medicaid and Medicare Services (CMS) issued proposed changes to the regulations governing Medicaid and Children’s Health Insurance Program (CHIP) managed care last week. The changes follow a comprehensive overhaul of the regulations in 2016. CMS announced that the newest proposals seek to rollback certain changes made in 2016 in an effort to provide more flexibility for states.

On April 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued instructions to Medicare Advantage plans encouraging more flexible service coverage policies in such plans for 2019. Such capitated plans cover the same services as traditional, fee-for-service Medicare, plus supplemental benefits adopted by the plan with CMS approval. Under the new CMS instructions, any Medicare Advantage plan would have additional flexibility to cover supplemental benefits to compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

On February 20, 2018, the Government Accountability Office (GAO) released a report recommending changes in federal policies and procedures governing state-operated Medicaid demonstration waiver projects.  These projects represent the leading edge in state Medicaid innovation as well as over $109 billion in federal Medicaid spending annually. GAO found in its review of these projects that the Centers for Medicare and Medicaid Services (CMS) has not always demanded thorough, scientifically valid, and timely data evaluations as to whether the projects achieved state-specified, CMS-approved goals to improve care and to contain costs.  

On February 9, 2018, President Trump signed H.R. 1892, the Bipartisan Budget Act of 2018.  The new law reauthorizes federal funding for many health programs, modifies scheduled reductions in Medicaid disproportionate share hospital (DSH) allotments to states, tightens third party liability (TPL) billing requirements, and updates requirements affecting Medicare Advantage plans, accountable care organizations (ACOs), and providers’ adoption of telehealth.