From KHI: Feds issue new rules on Medicaid waiver transparency

By Mike Shileds
KHI News Service
Feb. 23, 2012

TOPEKA — Federal officials have published new rules intended to make the Medicaid waiver process more open and responsive to public concerns.

The new rules, which become effective April 22, could have bearing on the waiver request the administration of Gov. Sam Brownback is preparing to submit to the U.S. Department of Health and Human Services as part of its effort to expand managed care within the state's Medicaid program.

Brownback officials on Jan. 26 submitted to federal officials a concept paper broadly outlining their upcoming waiver request. Officials have said they have "no timeline" for submitting the complete application, but they have announced they intend to launch their KanCare plan statewide beginning Jan. 1, 2013. Many of the plan's key provisions would need waiver approval.

In the concept paper, Kansas officials said they would seek an "1115" waiver, a type used for demonstration or pilot projects and which HHS has the broadest latitude to accept or reject. More than 35 states operate with some type of 1115 waiver, though they vary significantly in what they aim to accomplish or demonstrate.

The Kansas proposal, according to its outline in the concept paper and statements by administration officials, would be different than most 1115 waivers approved by the Obama or earlier administrations. Most proposals that have been approved included provisions that would expand Medicaid coverage to significant numbers of people otherwise not eligible. The Kansas plan, as outlined, would not do that.

Kansas officials also have said they want a far-reaching "global waiver" that would cap the amount of federal Medicaid dollars the state could receive in exchange for freedom from many or most federal Medicaid regulations. A global waiver, sometimes described as a block grant, has only been granted once in the history of the Medicaid program, and Obama officials have made it clear they do not support them.

The new federal rules were in response to changes in the waiver process included by Congress in the Affordable Care Act. Those changes in the law came after reports that HHS had done a poor job making the waiver process transparent and responsive to public input. Those concerns were heightened by a couple of relatively speedy waiver approvals during the administration of President George W. Bush, including a so-called global waiver for Rhode Island approved in the administration's final days and an earlier approval of a waiver request from Florida when the president's brother, Jeb Bush, was governor of that state.

Critics said those waivers were granted without proper public input.

"When Gov. Bush submitted the waiver to his brother's administration...Read more