New tool introduced to reconcile information sent in by state Medicaid rates with Medicare rates.

—Via AAHomecare, WASHINGTON, D.C. (December 14, 2017)—CMS recently provided an update on a State Operational Technical Advisory (SOTA) call regarding CURES Medicaid provisions. AAHomecare was one of nearly 300 participants on the call, which was put together for the benefit of Medicaid program officials, but also included industry stakeholders.

The discussion was the first public information provided to states on CURES, and clarified that the information applies only to primary Medicaid fee for service claims and does not include Medicaid managed care claims or secondary claims. While the information provided on the call had all been provided previously to AAHomecare, it did provide state Medicaid programs with the opportunity ask questions.

CMS introduced a tool they have created to reconcile information sent in by states and compare the state Medicaid rates with the Medicare rates, and explained the reporting process state Medicaid programs will need to follow emphasizing that reporting must be completed by March 30, 2019. With the new 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. CMS also 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 versus what the aggregate Medicare spend would have been for all products on this HCPCS list that have been furnished.

At this time, CMS has not formally published the state Medicaid director letter but expects to do so soon and will include the HCPCS list at that time. However, AAHomecare has received a preliminary copy of what will be included in the reconciliation from CMS, which we are sharing in two formats:

Please note: this list is preliminary and may change prior to final publication. CMS did acknowledge to AAHomecare that there was an error made on the call that suggested that oxygen products would not be included in the list. Upon clarification, CMS did confirm that oxygen was included in this provision. CMS has offered to work with the states now to determine if they are at risk for this from current spend or will be willing to look at on regular basis over the next year.

Washington and Indiana have indicated their intentions to move to Medicare rates via recent publications. Other states have reached out to state associations and AAHomecare indicating their intent 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. We have also engaged outside counsel to make sure we are providing legally-sound guidance.

See our updated CURES Medicaid Summary for further information.

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