CMS Announces Enhancements to Federal-State Partnerships

The March 18, 2013 CMS Letter to State Medicaid Directors details the CMS initiative to define responsibility and shared expectations in federal-state Medicaid partnerships. Specifically, it will create an executive work group, along with the National Association of Medicaid Directors (NAMD), to strengthen financial management and program integrity in the Medicaid program. CMS plans to also establish a regular state review process, develop data analysis tools, and require annual Upper Payment Limit (UPL) demonstrations. With New York seeking to tie much of the current State Medicaid reform efforts to federal initiatives that include grant and enhanced FMAP funding, it is critical to understand the nature of the partnership between DOH and CMS.

In the past, states were only required to submit UPL demonstrations when proposing amendments to reimbursement methodologies in their Medicaid plans. Beginning in 2013, states will be required to submit UPL demonstrations for inpatient hospital services, outpatient hospital services, and nursing facilities. In 2014, and annually thereafter, states will be required to submit UPL demonstrations for inpatient hospital services, outpatient hospital services, nursing facilities, clinics, physician services (if states reimburse targeted physician supplemental payments), Intermediate Care Facilities for the Developmentally Disabled (ICF/DD), private residential treatment facilities, and Institutes for Mental Disease (IMDs).

Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827