Medicaid fiscal accountability regulation Archives - Safety-Net Association of Pennsylvania

MFAR is Dead

At least for now.

The controversial Medicaid Fiscal Accountability Regulation, slated for implementation this fall over the objections of many health care stakeholders, will not move forward at this time.

In a tweet earlier this week, Centers for Medicare & Medicaid Services Administrator Seema Verma wrote that

We’ve listened closely to concerns that have been raised by our state and provider partners about potential unintended consequences of the proposed rule, which require further study. Therefore, CMS is withdrawing the rule from the regulatory agenda.

If implemented, opponents maintained, the regulation would have:

Deprived states of important, established policy-making prerogatives.
Created major new administrative burdens for state governments and hospitals.
Inappropriately regulated financing of the state share of Medicaid spending.
Introduced new, unspecified standards for state Medicaid programs.

While CMS maintained that MFAR would have enhanced the transparency of state Medicaid programs, the rule’s opponents maintained that it could lead to a major reduction of resources for serving the Medicaid population.

SNAP was among those opponents, arguing that the regulation could have hurt Pennsylvania safety-net hospitals and others that serve low-income communities by inappropriately regulating how states can finance their Medicaid programs. CMS proposed the rule last November; SNAP submitted formal comments expressing its opposition in January; and SNAP rallied Pennsylvania’s congressional delegation to oppose the rule in February, March, and July.

It is worth noting that in “withdrawing the rule from the regulatory agenda,” Verma did not preclude the possibility of reintroducing MFAR at some point in the future.

Learn more from article “Trump administration backing off Medicaid rule that states warned would lead to cuts” in the online publication The Hill.

PA Safety Net Admin2020-09-17T06:00:46+00:00September 17th, 2020|Federal Medicaid issues, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

MFAR Backlash Continues

Diverse health care and government interests are rallying around their opposition to the proposed Medicaid fiscal accountability rule.

Bookshelf with law books The regulation, proposed by the Centers for Medicare & Medicaid Services in November would impose new limits on the ability of states to finance their share of their Medicaid spending, potentially jeopardizing provider payments and the ability of high-volume Medicaid providers to operate without suffering great losses.

In all, CMS received more than 4200 written comments in response to the proposed regulation, most of them expressing opposition. Among those doing so were state governments, the National Governors Association, hospitals and hospital associations, nursing home operators, and health advocacy organizations. Also among them was the Safety-Net Association of Pennsylvania. In summarizing its opposition, SNAP wrote in a formal comment letter to CMS on behalf of Pennsylvania safety-net hospitals that

SNAP is concerned that this proposed regulation would inappropriately restrict the state’s ability to finance the non-federal share of the Medicaid program, would impose significant additional regulatory burdens – the cost of which would far outstrip their benefit – would inappropriately introduce subjectivity into the application of previously clear and objective regulatory standards, and is beyond the scope of the statutory authority granted to CMS.

See SNAP’s entire letter here.

Learn more about the Medicaid fiscal accountability rule, what it seeks to do, and why so many oppose in the Stateline article “Medical Groups Slam Trump Medicaid Rule.”

PA Safety Net Admin2020-03-04T06:00:15+00:00March 4th, 2020|Federal Medicaid issues, Medicaid supplemental payments|Comments Off

SNAP Rallies PA Delegation to Oppose MFAR

A proposed federal Medicaid regulation could limit Pennsylvania’s ability to finance its Medicaid program and jeopardize supplemental payments to the state’s private safety-net hospitals, so SNAP has asked members of the state’s congressional delegation to sign a letter to CMS Administrator Seema Verma asking her to reconsider the potentially damaging Medicaid fiscal accountability regulation.

Safety-Net Association of Pennsylvania logo In its letter to members of the state’s congressional delegation, SNAP wrote on behalf of private Pennsylvania safety-net hospitals that

The proposed Medicaid fiscal accountability regulation (MFAR) would, if implemented, impose new limits on how states may raise their share of funds to support their Medicaid programs. If adopted, the commonwealth would face a serious challenge raising the money it needs to finance its share of the cost of its Medicaid program. In addition, MFAR would take a great deal of states’ Medicaid policy-making authority away from state governments and give it instead to the federal Department of Health and Human Services.

Two members of the state’s congressional delegation, Representatives Brendan Boyle (D-Montgomery/Philadelphia) and Mike Kelly (R-Butler/Crawford/Erie/Lawrence/Mercer), have written a bipartisan letter to be sent to CMS Administrator Seema Verma asking her to reconsider the troubling aspects of MFAR. SNAP wrote to members of the state’s congressional delegation asking them to sign onto the letter.

Go here to see the full SNAP letter to the delegation.

PA Safety Net Admin2020-03-03T06:00:10+00:00March 3rd, 2020|Federal Medicaid issues, Pennsylvania Medicaid policy, Uncategorized|Comments Off

Fitch: Medicaid Block Grants, MFAR Threaten States, Providers

Medicaid block grants and the proposed Medicaid fiscal accountability regulation (MFAR) pose new financial threats to providers and states, according to Fitch Ratings, the financial rating company.

MFAR poses the greater threat, Fitch believes, noting in a new analysis that it could

…reduce total Medicaid spending nationally by $37 billion and $44 billion annually…and by $23 billion to $30 billion for hospitals alone. States, and to some extent providers, would respond to MFAR’s implementation with measures to mitigate the negative fiscal implications.

Bookshelf with law books Block grants, through what has been named the Healthy Adult Opportunity program, also pose a threat, with Fitch explaining that

Capping federal Medicaid contributions, even for a subset of beneficiaries, poses risks to state budgets and those entities reliant on state funding, including local governments and providers. States would need to find revenue or cost savings, either in Medicaid or elsewhere, to offset reduced federal contributions.

Because Pennsylvania safety-net hospitals care for more Medicaid patients than the typical hospital, both proposed policy changes have a potentially greater impact on them.

Last month SNAP conveyed its opposition to the proposed MFAR regulation in a formal comment letter to the Centers for Medicare & Medicaid Services in response to the regulation’s publication late last year. Pennsylvania Governor Tom Wolf has already rejected the idea of using block grants in the state’s Medicaid program.

Learn more about the potential impact of the proposed Medicaid fiscal accountability regulation and Medicaid block grants in the Fitch Ratings analysis “Fitch Rtgs: Medicaid Changes Will Affect States, NFP Healthcare Providers.”

PA Safety Net Admin2020-02-20T06:00:08+00:00February 20th, 2020|Federal Medicaid issues, Pennsylvania Medicaid, Pennsylvania safety-net hospitals, Safety-Net Association of Pennsylvania|Comments Off

Verma Responds to MFAR Critics

CMS administrator Seema Verma addresses criticism of her agency’s proposed Medicaid fiscal accountability regulation in a new commentary on the CMS blog.

Critics of the so-called MFAR regulation have argued that the Centers for Medicare & Medicaid Services’ proposed regulation, if adopted, will lead to a reduction of federal funding for state Medicaid programs, jeopardize access to care and the financial health of providers by leading to a reduction of supplemental payments to high-volume Medicaid providers, and possibly even force some states to raise taxes to compensate for the loss of federal funding.

In her commentary Verma rebuts these criticisms, maintaining that the proposed regulation seeks to ensure that states pay their fair share of their Medicaid partnership with the federal government, raise that share in a manner consistent with federal guidelines, and spend it in ways that fall within regulatory standards. She also maintains that the regulation will foster greater transparency and accountability for the Medicaid program.

Verma notes that more than 4000 stakeholders submitted written comments in response to the proposed regulation. SNAP was among those commenters, writing that MFAR would give too much authority to federal regulators; create new administrative burdens for hospitals and state governments; and inappropriately limit state financing of their share of Medicaid spending.

Learn more from the Verma CMS blog commentary “Medicaid Fiscal Integrity: Protecting Taxpayers and Patients” and from SNAP’s letter in response to the proposed regulation.

PA Safety Net Admin2020-02-14T06:00:39+00:00February 14th, 2020|Federal Medicaid issues, Safety-Net Association of Pennsylvania|Comments Off

Health Care Groups Rebel Against Proposed Federal Regulation, Program

The administration’s proposed Medicaid fiscal accountability regulation and its guidance encouraging states to implement Medicaid block grants have incurred widespread opposition among a variety of health care groups.

The Medicaid fiscal accountability regulation would, if adopted, impose new restrictions on how states raise their share of their Medicaid spending, potentially limiting state participation in Medicaid or necessitating tax increases to fill the funding gap if long-accepted financing tools are no longer available to them.

Bookshelf with law books The Medicaid block grant guidance offers states a blueprint for curtailing their Medicaid costs by imposing limits on that spending that they negotiate with the federal government.

Numerous health care groups have expressed reservations or direct opposition to one or both of the proposals. Among them:

AARP
America’s Essential Hospitals
America’s Health Insurance Plans
American College of Emergency Physicians
American Health Care Association
American Hospital Association
American Medical Association
Association for Community Affiliated Plans
Association of American Medical Colleges
Coalition of Long-Term Acute-Care Hospitals
LeadingAge
National Alliance of Safety-Net Hospitals
National Association of State Budget Officers
National Association of Medicaid Directors
National Continuing Care Residents Association
National Governors Association
Private Essential Access Community Hospitals

Among the groups submitting formal comment letters to the Centers for Medicare & Medicaid Services in response to the proposed Medicaid fiscal accountability regulation was the Safety-Net Association of Pennsylvania. See SNAP’s letter here.

Learn more about why these groups object to these two new policy developments in articles in Axios (“A little-noticed Medicaid proposal could have huge consequences”), Bloomberg Law (“Trump Plan to Tame State Medicaid Finance Schemes Sees Pushback”), Health Affairs (“Proposed Rules On Medicaid Financing Miss Mark And Threaten Access”), Healthcare Dive (“Payers, providers urge CMS to scrap rule targeting supplemental Medicaid payments”), Healthcare Finance News (“Providers, payers, others speak out against federal proposals for Medicaid funding”), McKnight’s Long-Term Care News (“Providers rally against proposed Medicaid supplemental payment rules that threaten ‘major financial burdens’”), McKnight’s Senior Living (“CMS proposal would be ‘major financial burden’ for CCRCs, residents, organizations say”), and U.S. News & World Report (“Governors Warn Trump Rule Could Lead to Big Medicaid Cuts”)

PA Safety Net Admin2020-02-10T06:00:34+00:00February 10th, 2020|Federal Medicaid issues, Safety-Net Association of Pennsylvania|Comments Off

SNAP Asks Feds to Withdraw Medicaid Financing Regulation

CMS should withdraw its proposed Medicaid fiscal accountability regulation, SNAP has suggested in a formal comment letter to the federal agency in response to a new regulation it proposed in November.

Safety-Net Association of Pennsylvania logo According to the comment letter SNAP submitted to the Centers for Medicare & Medicaid Services,

SNAP is concerned that this proposed regulation would inappropriately restrict the state’s ability to finance the non-federal share of the Medicaid program, would impose significant additional regulatory burdens – the cost of which would far outstrip their benefit – would inappropriately introduce subjectivity into the application of previously clear and objective regulatory standards, and is beyond the scope of the statutory authority granted to CMS.

Learn more about SNAP’s views on the proposed Medicaid fiscal accountability regulation and why SNAP believes CMS should withdraw it in SNAP’s formal comment letter.

PA Safety Net Admin2020-02-03T06:00:47+00:00February 3rd, 2020|Federal Medicaid issues, Safety-Net Association of Pennsylvania|Comments Off

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