The Republican Governors Public Policy Task Force, representing 31 Republican state governors, has released a report outlining 31 "solutions" to reform the Medicaid program.
The report, "A New Medicaid: A Flexible, Innovative and Accountable Future" (pdf), was offered in response to a request by House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and Senate Finance Committee Ranking Member Sen. Orrin Hatch (R-Utah) and builds upon a list of seven principles offered in June by the Republican governors.
The 31 recommendations to reform Medicaid include:
1. Provide states the option to define and negotiate a broad outcome-based Program Operating Agreement with CMS.
2. Allow states to create a specific "dashboard" to measure accountability utilizing recognized measures of quality, cost, access and customer satisfaction that reflects the states' priorities and permits an assessment of program performance over time.
3. Repeal Maintenance of Effort requirements established by the PPACA, returning flexibility to states and allow them to make changes in eligibility.
4. Make program integrity the responsibility of the state. Currently, common practice is to utilize federal contractors for program integrity initiatives, most of whom are not familiar with individual state.
5. Require the federal government to take full responsibility for the uncompensated care costs of treating illegal aliens.
6. Allow states to pilot self-directed alignment structures for state and federal healthcare programs to reduce the incidence of cost-shifting from one program to another, encourage efficiency in complementary programs and ensure program integrity.
7. Federal and state financial participation in the Medicaid program should be rational, predictable and reasonable. Here, the report adds, "the dramatic expansion of Medicaid scheduled for 2014 could have dire consequences on the management of the program."
8. If a state can demonstrate budget neutrality, provide states the ability to use state or local funding, now spent as match funding, for certain health services that would pay for Medicaid services or health system improvements that are currently not "matchable," but are cost effective and improve the value of the Medicaid program.
9. States should be encouraged to develop innovative programs to reduce chronic illnesses and the burden of associated healthcare costs to individuals and the taxpayers.
10. This solution expands upon how responsibility for program integrity should be returned to the states.
11. Provide states with the flexibility, without requesting waivers or initiating the state plan amendment process, to pay providers based on providers meeting quality care and value-based criteria rather than the current fee-for-service approach.
12. Provide states with the ability to implement bundled payment projects.
13. Give states the ability to use only one managed care organization if client volume in an area is insufficient to support two.
14. Establish reasonable, rational and consistent asset tests for eligibility.
15. Give states the flexibility to streamline and improve the eligibility determination system by contracting with private firms.
16. Within a state's fair share of federal funding, there should be significant flexibility regarding how a state provides eligibility for its population in need.
17. Eliminate the marriage penalty.
18. Eliminate the obsolete mandatory and optional benefit requirements.
19. Eliminate benefit mandates that exceed the private insurance market benchmark or benchmark equivalent
20. Purchase catastrophic coverage combined with an HSA-like account for the direct purchase of healthcare and payment of cost sharing for appropriate populations determined by each state.
21. Provide states the option of rewarding individuals who participate in health promotion or disease prevention activities.
22. Provide states with the ability to offer "value-added" or additional services for individuals choosing a low-cost plan or managed care plan.
23. Allow states the option of contributing to a private insurance benefit for all members of the family.
24. Lower the threshold for premium payments to 100 percent of the federal poverty level to encourage a sense of shared beneficiary ownership in healthcare decisions.
25. U.S. territories should be treated consistently, fairly and rationally in funding, services and program design.
26. At a state's discretion, permit states to redesign Medicaid into multiple parts. Medicaid Part A would focus on preventive, acute, chronic and palliative care services; and Part B would focus on long-term supports and services.
27. Engage in shared savings arrangements for dual eligible members when the state can demonstrate the Medicare program reduced costs as a result of an action by a state Medicaid program.
28. Repeal restrictions that impede self-direction of long-term care supports and services and allow states the ability to design programs that meet their needs and are cost effective.
29. At the state's option, replace Medicare cost-sharing with state-administered, 100 –percent federal grants.
30. Give states the flexibility to enroll more members, especially families, in premium assistance programs including Medicare benefits, when it is cost efficient.
31. Extend Medicare coverage of skilled nursing facilities by 60 days.
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The report, "A New Medicaid: A Flexible, Innovative and Accountable Future" (pdf), was offered in response to a request by House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) and Senate Finance Committee Ranking Member Sen. Orrin Hatch (R-Utah) and builds upon a list of seven principles offered in June by the Republican governors.
The 31 recommendations to reform Medicaid include:
1. Provide states the option to define and negotiate a broad outcome-based Program Operating Agreement with CMS.
2. Allow states to create a specific "dashboard" to measure accountability utilizing recognized measures of quality, cost, access and customer satisfaction that reflects the states' priorities and permits an assessment of program performance over time.
3. Repeal Maintenance of Effort requirements established by the PPACA, returning flexibility to states and allow them to make changes in eligibility.
4. Make program integrity the responsibility of the state. Currently, common practice is to utilize federal contractors for program integrity initiatives, most of whom are not familiar with individual state.
5. Require the federal government to take full responsibility for the uncompensated care costs of treating illegal aliens.
6. Allow states to pilot self-directed alignment structures for state and federal healthcare programs to reduce the incidence of cost-shifting from one program to another, encourage efficiency in complementary programs and ensure program integrity.
7. Federal and state financial participation in the Medicaid program should be rational, predictable and reasonable. Here, the report adds, "the dramatic expansion of Medicaid scheduled for 2014 could have dire consequences on the management of the program."
8. If a state can demonstrate budget neutrality, provide states the ability to use state or local funding, now spent as match funding, for certain health services that would pay for Medicaid services or health system improvements that are currently not "matchable," but are cost effective and improve the value of the Medicaid program.
9. States should be encouraged to develop innovative programs to reduce chronic illnesses and the burden of associated healthcare costs to individuals and the taxpayers.
10. This solution expands upon how responsibility for program integrity should be returned to the states.
11. Provide states with the flexibility, without requesting waivers or initiating the state plan amendment process, to pay providers based on providers meeting quality care and value-based criteria rather than the current fee-for-service approach.
12. Provide states with the ability to implement bundled payment projects.
13. Give states the ability to use only one managed care organization if client volume in an area is insufficient to support two.
14. Establish reasonable, rational and consistent asset tests for eligibility.
15. Give states the flexibility to streamline and improve the eligibility determination system by contracting with private firms.
16. Within a state's fair share of federal funding, there should be significant flexibility regarding how a state provides eligibility for its population in need.
17. Eliminate the marriage penalty.
18. Eliminate the obsolete mandatory and optional benefit requirements.
19. Eliminate benefit mandates that exceed the private insurance market benchmark or benchmark equivalent
20. Purchase catastrophic coverage combined with an HSA-like account for the direct purchase of healthcare and payment of cost sharing for appropriate populations determined by each state.
21. Provide states the option of rewarding individuals who participate in health promotion or disease prevention activities.
22. Provide states with the ability to offer "value-added" or additional services for individuals choosing a low-cost plan or managed care plan.
23. Allow states the option of contributing to a private insurance benefit for all members of the family.
24. Lower the threshold for premium payments to 100 percent of the federal poverty level to encourage a sense of shared beneficiary ownership in healthcare decisions.
25. U.S. territories should be treated consistently, fairly and rationally in funding, services and program design.
26. At a state's discretion, permit states to redesign Medicaid into multiple parts. Medicaid Part A would focus on preventive, acute, chronic and palliative care services; and Part B would focus on long-term supports and services.
27. Engage in shared savings arrangements for dual eligible members when the state can demonstrate the Medicare program reduced costs as a result of an action by a state Medicaid program.
28. Repeal restrictions that impede self-direction of long-term care supports and services and allow states the ability to design programs that meet their needs and are cost effective.
29. At the state's option, replace Medicare cost-sharing with state-administered, 100 –percent federal grants.
30. Give states the flexibility to enroll more members, especially families, in premium assistance programs including Medicare benefits, when it is cost efficient.
31. Extend Medicare coverage of skilled nursing facilities by 60 days.
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