CMS is streamlining the Medicaid review process and reducing approval times so states can manage their programs more effectively.
CMS is streamlining the Medicaid review process and making it more transparent, efficient, and less burdensome in an effort to speed up approval times for state programs.
“At CMS, we are making great progress to transform Medicaid, which is CMS’s largest program serving 72.5 million beneficiaries,” CMS Administrator Seema Verma wrote in a recent blog post.
“We are working to reset the federal-state relationship and restore the partnership between the states and the federal government, while at the same time modernizing the program to deliver better outcomes for the people we serve.”
Verma charged a CMS team to collaborate with states and make the state plan amendment and 1915 waiver review process more efficient. This would reduce processing times, as these procedures represent the majority of approvals states need to change program benefits, rates, and eligibility requirements.
Verma emphasized the important role states played in developing Medicaid program improvements.
“Soliciting state input was essential to this process,” she wrote. “State feedback was received through a variety of mechanisms to ensure that any process improvement activities were comprehensive and responsive to state needs. To facilitate collaboration, we formed a federal-state workgroup with representatives from more than a dozen states.”
These changes have resulted in a 16 percent decrease in median approval times for Medicaid SPAs between 2016 and 2018. In 2018, 78 percent of SPAs were approved within the first 90-day review period, a 14 percent increase from 2016.
Between 2016 and 2018, median approval times for 1915(b) waivers decreased by 11 percent, 1915(c) renewal approval times decreased by 38 percent, and 1915(c) amendment approval times decreased by 28 percent.
The improvements also reduced the backlog of pending SPA and 1915 waiver actions pending additional information from states by 80 percent.
“With faster processing times and earlier communication, states now have much greater ability to manage their programs in an effective and predictable manner,” Verma wrote.
“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.”
The CMS team that worked on streamlining the Medicaid review process received one of the first Gears of Government Awards from the White House Office of Management and Budget. The award recognizes federal employees who contribute significantly to the vision of an effective, modern government.
Verma noted that while CMS has made substantial progress, the agency still has more to do to increase bureaucratic efficiency.
“Our partnership with states on process improvement and the implementation of the new strategies has resulted in more efficient and timely processing of SPA and 1915 waiver actions, reducing administrative burden for states,” Verma wrote.
“We have now begun a similar effort to achieve similar improvements in processing times for managed care contracts and rate approvals.”
With these improvements, CMS expects to help reduce burdensome administrative tasks for states and improve Medicaid processes.
“These efforts enable states to more effectively manage their programs and ensure that they can focus on their most important job – achieving positive health outcomes for the vulnerable individuals and families the program serves,” Verma concluded.
“We look forward to continued collaboration to ensure these processes are transparent, efficient, and less burdensome.”
Date: May 13, 2019