Dear Association Executives – This afternoon, HHS' Center for Medicare & Medicaid Services (CMS) and Center for Medicaid & CHIP Services (CMCS) issued an informational bulletin stating that they will not undertake certain Medicaid enforcement actions "to enable critical Medicaid funds to continue to flow to providers" due to the Change Healthcare cybersecurity incident.
In particular, the informational bulletin (CIB) states, "This CIB outlines a framework under which CMS will permit states to expedite these interim payments to providers while maintaining key guardrails to protect program integrity. As discussed in more detail below, the interim payments that CMS would permit under this framework would be limited to no more than recent prior period (that produces the most accurate interim payment amounts) Medicaid payments for an equivalent service period on a provider specific basis. The flexibility would only be available for affected providers, and for affected service periods through no later than June 30, 2024, and subject to reconciliation using actual individual service-specific data once states regain access to this data at the resolution of the cybersecurity incident. CMS will permit states to take advantage of this framework only if they develop and submit a Medicaid SPA, within timeframes described in this CIB and have CMS approval prior to June 30, 2024, to obtain authority to make payments in this manner until regular operations can resume."
You can see the new guidance here: https://www.medicaid.gov/sites/default/files/2024-03/cib031524.pdf
And the CMS statement here: https://www.cms.gov/newsroom/press-releases/statement-change-healthcare-non-enforcement-medicaid-informational-bulletin
Please let us know if you have questions or if additional information would be helpful.
Thank you –
Reyna
Reyna Taylor
Senior Vice President, Public Policy and Advocacy
ReynaT@thenationalcouncil.org
Direct – 202-774-1651
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Neal Comstock
Director of Membership
National Council
NealC@TheNationalCouncil.org202 748-8793
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