CMS focused on Medicaid integrity, agency deputy says

As Medicaid spending continues to increase, the CMS hopes focusing on flexbility, accountability and the integrity of managed care plans will help slow that growth, an agency official said Wednesday.

CMS’ acting deputy administrator and acting director Calder Lynch called the spending growth “unsustainable,” as it’s slated to hit $1 trillion per year by 2026. That encourages the CMS to continue its push to curb growing healthcare spending by giving state Medicaid programs more flexibility and help with value-based payment experiments. The agency will also continue its efforts to reduce unnecessary regulatory burdens for states, plans and providers, he said during remarks at America’s Health Insurance Plans’ 2019 national conference on Medicaid.

Better administrative and quality accountability measures such as a new Medicaid and Children’s Health Insurance Program scorecard would improve the ability of states and the CMS to advance multi-payer alignment through streamlined payment policies, quality measurements, administrative practices and data sharing, Lynch said.

Every state is required to have a written Medicaid quality strategy and related performance assessments, but Lynch said that they often fail to inform a comprehensive strategy to improve state Medicaid programs.

“Too often they become a check-the-box exercise,” he said.

The agency will focus on improved data collection and sharing over the next year, and it’s now collecting transformed Medicaid statistical information system data from all states. That data provides more comprehensive claims and beneficiary information to the agency.

“It’s a critical element for us to get a full picture of the quality of services that are being delivered,” Lynch said. But the data has its problems and “patience for complete and accurate Medicaid data is running out.”

Focusing on Medicaid integrity will also help improve the accuracy of medical-loss ratios, Lynch said, noting that managed care plans had artificially inflated their MLRs through improper reporting to increase their earnings.

“This is going to be a trust, but verify kind of activity,” he said.

The agency is also working to make sure that states and managed care plans aren’t enrolling ineligible people in Medicaid, citing recent reports that states often fail to prevent ineligible people from enrolling in the program. Lynch said it’s especially true for states where the federal government is paying for most of the Medicaid costs.

“There’s little incentive for states to make sure they’re guarding against inappropriate enrollments,” he said.

https://www.modernhealthcare.com/politics-policy/cms-focused-medicaid-integrity-agency-deputy-says