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CMS Guidance on Continuous Eligibility for Children

• On September 29, CMS issued a State Health Official (SHO) letter to provide states with guidance on implementing 12 months of continuous eligibility (CE) for children under the age of 19 in Medicaid and the Children’s Health Insurance Program (CHIP), effective January 1, 2024. SHO# 23-004 provides information on the importance of CE in preventing interruptions to health care coverage and how to support better short- and long-term health outcomes. In addition, CMS provides a description of policies related to implementing CE under the Consolidated Appropriations Act’s (CAA) 2023 amendments and highlights the differences between the CE requirements that existed prior to and those specified in the CAA. Finally, SHO# 23-004 clarifies which states will need to submit Medicaid and CHIP state plan amendments (SPA) and reminds states that section 1115 demonstration authority may also serve as a vehicle to extend the CE period for children beyond 12 months and/or to apply CE to adults (CMS, September 29).

CMS Guidance on Medicaid Transportation

• On September 28, CMS issued a State Medicaid Director letter, the Medicaid Transportation Coverage Guide (SMD #23-006), which serves as a comprehensive compilation of current and new Medicaid transportation policies. The guidance addresses the federal requirements for and flexibilities given to states to provide beneficiaries greater access to Medicaid transportation services relating to both emergency transportation and non-emergency medical transportation (NEMT). CMS reminds states that the assurance of transportation is not a requirement to pay for a ride, but a requirement to make sure that every beneficiary without a means of transportation has access to such transportation in order to receive covered care. Transportation has a key role in health equity and ensuring that all beneficiaries have access to healthcare services regardless of race, ethnicity, disability, sex, socioeconomic status, geography, language, and other factors (CMS, September 28).

Continuing Resolution Averts Government Shutdown

• Congress passed a continuing resolution (CR) on Saturday, September 30, preventing a government shutdown by providing temporary funding until November 17. The CR extends funding for certain HHS programs, including graduate medical education programs, community health centers, and the National Health Service Corps but the makeup of a final budget remains uncertain. Additionally, Medicaid DSH pay cuts were delayed until mid-November. However, the SUPPORT Act, maternal health programs, pandemic preparedness, and other programs were left unfunded. Many of these programs face uncertainty due to partisan divides, with issues such as the abortion pill mifepristone creating obstacles to passing an appropriations bill. If a longer-term spending deal is not reached in six weeks, a government shutdown is possible. This would impact various HHS agencies, FDA investigations, and Medicaid oversight as the program continues the critical unwinding process (Inside Health Policy, September 30).

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SPAs

• COVID-19 SPAs
  • New York (NY-23-0067, effective May 12, 2023): Provides a temporary extension of the American Rescue Plan Act (ARPA) initiative regarding COVID-19 Test and Specimen Collection as originally authorized under Disaster Relief SPA NY-20-0048. Additionally, this SPA temporarily extends private duty nursing provided to fee-for-service (FFS) individuals who have aged out of the medically fragile children’s reimbursement program as originally approved under Disaster Relief SPA NY-21-0073.
• Payment SPAs
  • California (CA-22-0012, effective January 1, 2022): Renews the rate setting methodology for freestanding skilled nursing facilities Level-B (FS/NF-B) and freestanding adult subacute facilities (FSSA) and provides a 2.4 percent increase in the statewide weighted average Medi-Cal reimbursement rate for FS/NF-B and FSSA facilities.
  • Indiana (IN-23-0015, effective October 1, 2023): Authorizes an exemption from the Recovery Audit Contractor (RAC) program.
  • Iowa (IA-23-0009, effective April 1, 2023): Updates the non-aggregate quality assurance assessments to the maximum aggregate non-Medicare revenues of a nursing facility.
  • Iowa (IA-23-0019, effective July 1, 2023): Implements new dental payment rate adjustments for state-owned dentistry clinics.
  • Minnesota (MN-23-0024, effective January 1, 2024): Changes rates for intermediate care facilities, personal care assistants, and home care services.
  • South Carolina (SC-23-0009, effective July 1, 2023): Increases rates and service limits for two autism spectrum disorder (ASD) services and adds two additional codes with service descriptions to the ASD Services Manual.
  • Utah (UT-23-0013, effective July 1, 2023): Updates inpatient hospital services reimbursement methodology.
• Services SPAs
  • California (CA-23-0034, effective October 1, 2023): Clarifies existing policy for preventive services regarding mandatory coverage requirements for approved adult vaccines to comply with CMS guidance in State Health Official (SHO) Letter 23-0003.
  • Massachusetts (MA-23-0015, effective January 1, 2023): Adds enhanced mobile crisis services as rehabilitative services to the Medicaid State Plan.
  • Oregon (OR-23-0025, effective July 1, 2023): Adds providers into the other licensed providers section of the state plan.
  • Washington (WA-23-0019, effective July 1, 2023): Updates the state’s Preferred Drug List if drug shortages occur.
  • Washington (WA-23-0042, effective July 1, 2023): Increases the daily rates for personal care services provided in Adult Family Homes, Adult Day Respite, Enhanced Service Facilities, and Assisted Living Facilities provided by both Agency Providers and Consumer Directed Employers.

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