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

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!

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