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  • 1.  Potential Impact on CMHC Providers over Medicaid Fiscal Accountability Regulation CMS-2393-P

    Posted 11-18-2019 14:08
      |   view attached

    Hi Colleagues:


    Great seeing so many of you at the State Execs Retreat in the Coachella Valley last week.  Kudos to Doyle, Paul, and the rest of the planning committee on a great retreat!

    Nothing like coming back on a Monday to process the just released CMS Medicaid Fiscal Accountability Proposed Regulation (CMS-2393-P).  Please see attached.  This proposed rule could have a significant impact on our Medicaid Rehabilitation program in Indiana due to our financing arrangement and the flow of IGT dollars to cover Medicaid match.  This proposed rule could be especially acute for those who aren't instrumentalities of state and local government.

    I know it's early and you may not have fully digested, but I was curious if this regulation may have an impact on your state and how you are planning to respond?  Some of you old timers, like me, may remember when we addressed something similar in the waning years of the Bush administration, but the rule was abandoned once Obama took office.  Thanks for any insight. 





    Matthew G. Brooks, MA

    President & Chief Executive Officer

    Indiana Council of Community Mental Health Centers, Inc.

    101 W. Ohio Street, Suite 610

    Indianapolis, IN  46204

    317-684-3684 (office)



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    CMS-2393-P.pdf   313 KB 1 version

  • 2.  RE: Potential Impact on CMHC Providers over Medicaid Fiscal Accountability Regulation CMS-2393-P

    Posted 11-19-2019 09:29

    Matt, I saw this rule but don't understand how it could potentially impact our members. For those of us who aren't old-timers, can we get some help digesting the rule and evaluating what, if any, impact it could have for our members?




    Shannon Hall

    Executive Director

    Community Behavioral Health Association of Maryland

    (410) 788-1865

    CBH Logo



  • 3.  RE: Potential Impact on CMHC Providers over Medicaid Fiscal Accountability Regulation CMS-2393-P

    Posted 11-19-2019 16:11

    Dear Association Execs,


    The National Council has conducted a preliminary analysis of the proposed rule, available here. Additional information is available in this fact sheet from CMS.


    The rule spans 200+ pages and there is a lot in there, but these are a few key takeaways for you to know:


    1. If finalized, the rule will result in greater scrutiny of supplemental payments, Intergovernmental Transfers (IGTs), Certified Public Expenditures (CPEs), and situations in which providers are being taxed or contributing resources (financial or otherwise) to their state to help draw down the federal match for Medicaid services. If your state engages in any of these strategies to generate the state share of the match, you will want to take a close look at the proposed rule.
    2. The primary thing CMS is trying to ascertain is whether IGTs and CPEs are drawn exclusively from state or local tax funds. They are also examining whether there is a "hold harmless" expectation in which providers that donate or are taxed have a formal or informal guarantee of receiving those funds back in the form of higher Medicaid reimbursement. Finally, they are trying to get better data about the use of supplemental payments in Medicaid given that these represent a growing share of total Medicaid expenditures.
    3. In addition to the increased reporting requirements and more detailed definitions outlined in the rule, CMS is proposing to sunset supplemental payment models after 3 years to give the agency a chance to review and re-approve.
    4. To the extent that the net impact of these changes is a reduction in the total amount of Medicaid funds available to a state, it could impact behavioral health providers even if your members aren't receiving supplemental payments or engaging in IGTs/etc.


    The National Council will be preparing comments on this proposed rule, and to that end we are seeking input from you on whether you foresee a direct or indirect impact on your members. Please reach out to me by phone or email to share your thoughts – and we can also add this to the agenda for our next monthly AE call if it would be helpful to you.


    Thank you,



    Rebecca Farley David
    Senior Advisor, Public Policy & Special Initiatives
    National Council for Behavioral Health
    1400 K Street NW Suite 400, Washington, DC 20005
    Direct: (202) 684-3735

  • 4.  RE: Potential Impact on CMHC Providers over Medicaid Fiscal Accountability Regulation CMS-2393-P

    Posted 12-05-2019 09:22

    Maryland is switching its ASO vendor, who is responsible for managing auths and paying claims for publicly-funded services, on January 1. The transition planning period has taken place in less than three months and, at this point, we have strong concerns that a working payment process will not be in place by January 1st.


    In a past ASO transition that didn't go well, Maryland fronted payments to providers – and faced years of audit problems afterward. This has created a greater reluctance to consider upfront payment.


    hear Ohio providers got upfront payments from their county boards during disruptions in the system redesign, and that Arkansas providers received upfront assistance during an ASO transition. I'd love to hear more about how these worked – and anything from other states who handled payment disruptions with effective work-arounds.  


    Appreciate any examples or advice you can offer!


    Shannon Hall

    Executive Director

    Community Behavioral Health Association of Maryland