CMS Medicaid Regulations

May 1, 2008

The US Senate began on April 28 to consider a bill approved by the House last week imposing a moratorium through April 1, 2009 on seven CMS Medicaid regulations. The Senate rejected on April 29 a motion to bypass Senate hearings and immediately vote on the House bill. CMS confirmed that it may modify provisions on intergovernmental transfers under the public provider reimbursement rule, graduate medical expenses incurred by hospitals, and billing units for case management services.

The George Washington University School of Public Health released an excellent report last week demonstrating that a requirement for one case manager for each individual under the CMS rule would prohibit the use of teams responsible for coordinating the care of individuals with complex physical and behavioral health needs in community settings. GWU presented a strong argument, which should influence Senate consideration of the case management rule, that CMS overlooked important clinical practice issues in drafting the rule. The case management rule, the public provider reimbursement rule, and restrictions on SCHIP expansions remain under attack in three on-going federal lawsuits that have been filed since March, involving 10 states.  

 

Tom Entrikin

Tom Entrikin is a PCG manager and former Medicaid policy specialist with the U.S. Health Care Financing Administration (HCFA), now the Centers for Medicare & Medicaid Services (CMS).