CMS streamlines Medicaid waiver processes for states and decreases approval wait times
States are required to get CMS approval for any changes they want to make to their Medicaid programs, no matter how simple.
The Centers for Medicare and Medicaid Services announced changes to the Medicaid Review Process that the agency said will mean a significant reduction in approval times. The changes facilitate faster processing of state requests to make program or benefit changes to their Medicaid program through the state plan amendment 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."
States are required to get CMS approval for any changes they want to make to their Medicaid programs, and those changes are made through an SPA or section 1915 waiver. That process is required even for simple updates, meaning states must wait through a months-long federal review process.
CMS had previously unveiled an initiative to improve the processes by holding 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; implementing new tools to facilitate the development of complete submissions; reducing a the backlog of state requests; and expanding the use of MACPro, a web-based system for processing requests.
In collaboration with CMS and individual states, CMS modified the review process for SPAs and reported the results of those efforts: a 23 percent decrease in the median approval time for Medicaid SPAs between calendar year 2016 and first quarter 2018; 84 percent of Medicaid SPAs were approved within the first 90-day review period in first quarter of 2018, a 20 percent increase over calendar year 2016; a 7 percent decrease in median approval times for HCBS waivers; a 38 percent decrease in HCBS renewal approval times; and amendment approval times dropped 44 percent for long-term care services.
"A work group was formed between CMS and representatives from over a dozen states and representatives of their national associations," CMS added. "The combined focus by both CMS and states on SPA and 1915 waiver processing and implementation of improvement strategies is proving successful."
Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com
