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CMS Strategy for Medicaid Emphasizes Greater Flexibility for States in Waiver Implementation as well as Public Scorecards

In two recent Washington DC meetings, Seema Verma, Administrator for the Centers for Medicare and Medicaid (CMS) underscored new CMS policies that encourage states to propose innovative Medicaid reforms.  “Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve. We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential.”

Verma pledged to remove impediments to the federal approval and oversight process for state requested waivers.  She emphasized that the goals of these innovations is to improve health outcomes and quality of life for Medicaid beneficiaries. revised website content signals a broader view of Section 1115 Demonstrations and 1915 Waivers. The new content focuses on evidence based interventions to support innovative delivery and payment models, as well as evidence of better health outcomes and improvement in quality of life.

For CHAP accredited providers, they will see the beginning of value-based purchasing as the provisions for the new waivers include Medicaid and CHIP Scorecards. Similar to current providers’ experience with Medicare outcomes and star-ratings, CMS is in the early stages of developing Scorecards to provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes. Even a Home and Community Based Services CAPHS survey is now available for use by states. 

CHAP accredited providers have a strong foundation on which to build this new level of accountability in Medicaid.  The CHAP Standards of Excellence and award of accreditation importantly emphasize patient rights, assessment of patient need and preference, and care planning and coordination by competent staff.  These key performance areas are key to achieve desired outcomes for any patient population.  CHAP accredited providers are well-positioned to demonstrate the quality of their care for the growing Medicaid population, whose goals focus on a quality life in their home and their chosen community.