By So as Part 1 described it is a little hard to predict what the role of waivers will be in the new world. But one thing we do know is that more standards regarding transparency and public participation are coming our way. And they are coming soon - one of the first things out of the box. Yeah!!
OK, I know, this is a niche thing but we have been highlighting the need for more transparency and public participation in the waiver process for years (and years). Often critical and high stakes decisions about Medicaid financing, and the benefits that beneficiaries will receive (among other things) are made in closed-door negotiations between the state and the federal government. Beneficiaries and their advocates and providers have little input into the process. Members of both parties in Congress have been concerned about this trend for some time, and the GAO has issued numerous reports over the years highlighting these concerns.
So in two separate provisions, the Patient Protection and Affordable Care Act (PPACA) directs the Secretary of Health and Human Services to promulgate regulations that establish a process for public notice and comment at the state and federal levels (Geeky bill readers see Section 10201 (i) and Section 1332 (a)(4)(B) for the new waiver for state innovation provision.) And the statute directs the Secretary to issue the rules within 180 days of the date of enactment (that would be on or about September 23, 2010). So this is one of the first things that CMS has to do and they are already hard at work thinking about it.
To help them think those great thoughts, we developed a set of recommendations in conjunction with our partner in crime on this issue, the Center on Budget and Policy Priorities, and a diverse list of consumer and provider groups who have followed waiver issues closely with us through an informal "Waiver Task Force" that I have co-chaired with Judy Solomon at CBPP for a number of years. Let us know if you have other ideas, and stay tuned for the regulations when they come out - no doubt they will be issued as proposed so there will be an opportunity for public comment in September.
Also while we are on the topic a big shout out to CMS for including a public notice requirement in their recent final regulation on "benchmark" benefit rules in Medicaid.
Even though these changes can be made through state plan amendments, they can be of fundamental importance to beneficiaries so having an opportunity for public notice and comment is essential.
So we will revisit this issue in the fall when the proposed rules come out. This is probably a good chance for me to mention that I will be in foreign lands for the summer with my family. To be specific, we are headed to Bolivia for about 8 weeks as my husband dives into some human rights questions there, and the girls and I attempt to learn some Spanish and soak up the culture. I will be back at work on September 1st just in time to pick up this issue for the next round!
Being in a Medicaid waiver state, Tennessee, transparency rules will be great. I cannot tell you how frustrating it has been to have no avenue to discuss or know what the state and CMS are about to agree upon. We only found out the result. We were not involved in the beginning or the middle, we were only involved with what came out at the end. State legislators were equally frustrated. They were told what the result was. The entire process was controlled by the governor and/or the Medicaid Director. Public input from consumers and other policymakers was nil.
I hope you will submit public comments when the time comes! We will keep you posted.