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).