CMS NEWS
FOR IMMEDIATE RELEASE
August 16, 2018
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS Streamlines Medicaid
Review Process, Achieves Significant Reduction in Approval Times
Today, the Centers for Medicare and Medicaid Services (CMS) announced
significant improvements in managing the Medicaid program in partnership
with states. Identified early as a priority for both the Trump
Administration and the National Association of Medicaid Director’s (NAMD),
CMS has implemented changes resulting in faster processing of state
requests to make program or benefit changes to their Medicaid program
through the state plan amendment (SPA) and section 1915 waiver review
process.
“With faster processing times and earlier communication, states now have
much greater ability to manage their programs in an effective and
predictable manner,” said CMS Administrator Seema Verma. “We want to ease
bureaucratic requirements for both states and our own staff so that we can
focus those resources on improving health outcomes rather than pushing
paperwork.”
When states want to make changes to their Medicaid programs, they
require approval from CMS. Typically these changes occur through a SPA or
section 1915 waiver – even for simple updates, which sometimes require
states to endure a months-long federal review process, thus creating a
substantial burden for both states and CMS.
At the end of 2017, CMS issued a bulletin
announcing an initiative to revamp these processes, highlighting four
specific improvements: 1) a call with states within 15 days of receipt of
each submission to review the state’s request and any critical timelines to
help expedite the review process; 2) launch of new tools available to
states to facilitate the development of complete submissions; 3) implementation
of a strategy to reduce a significant backlog of state requests and 4)
expanding the use of MACPro, a web-based system for processing
requests.
Today, CMS is following up with a new bulletin that highlights the
successes of implementing the above strategies, outlines two additional
long-term process improvements CMS is implementing, and highlights specific
enhancements made to the review process for SPAs and 1915 waivers.
Through extensive collaboration with states on this effort, CMS has achieved
the following:
- Between calendar
year 2016 and the first quarter of 2018, a 23 percent decrease in the
median approval time for Medicaid SPAs.
- Eighty-four percent
of Medicaid SPA were approved within the first 90-day review period in
the first quarter of 2018, a 20 percent increase over calendar year
2016.
- Between calendar
year 2016 and the first quarter of 2018, median approval times for
HCBS waivers decreased by 7 percent. HCBS renewal approval times
decreased by 38 percent and amendment approval times decreased by 44
percent for long-term care services.
To achieve this success, CMS undertook a significant effort to
understand current processes and collaborated closely with states to
understand where there was room for improvement and identify solutions.
A work group was formed between CMS and representatives from over a dozen
states and representatives of their national associations. The
combined focus by both CMS and states on SPA and 1915 waiver processing and
implementation of improvement strategies is proving successful.
“We are appreciative of CMS for reaching out to state agencies for
feedback on an improved process for 1915(c) HCBS Waiver applications and
amendments and for responding so quickly to address issues identified
through that engagement. States have reported that the new practice
by CMS to call states within 15 days of a submission has been very
beneficial, resulting in better applications and faster approvals” said
Mary Lee Fay, Executive Director of the National Association of State
Directors of Developmental Disabilities Services (NASDDDS).
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