As the COVID-19 pandemic continues to progress, providers across the continuum of care are experiencing significant changes in utilization resulting in declining revenue and jeopardizing access to care. The federal government has acknowledged the financial challenges facing providers through supplemental funding included in the three federal stimulus bills enacted to date—the Coronavirus Aid, Relief, and Economic Security Act (CARES Act); the Families First Coronavirus Response Act; and the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020. In addition, several states have submitted Section 1115 waivers requesting CMS approval to establish “disaster relief funds,” paid for with Medicaid dollars, to further assist providers. States are increasingly seeking innovative strategies to leverage Medicaid authorities to support the essential and vulnerable providers on the frontlines of the pandemic.
State Health & Value Strategies hosted a webinar in which experts from Manatt Health walked through tools states can use to increase payments to providers through both fee-for-service and Medicaid managed care, despite COVID-19 driven changes to utilization. As a companion to the webinar, Manatt Health produced a toolkit for states that identifies the immediately available tools that can help ensure payments continue flowing to providers despite substantial utilization changes resulting from COVID-19.
The webinar and toolkit include strategies for Medicaid fee-for-service and managed care, and they draw from but modify existing practice. Some may require CMS approval, including, in some instances, 1115 waiver authority. The requests, however, are narrow, and they build on approved payment mechanisms. When they need to be reviewed by CMS, they could be acted on quickly, particularly if CMS continues its current approach of providing unprecedented levels of flexibility (e.g., in 1135 waivers) in response to the COVID-19 challenge. To ensure the strategies are as effective as possible, states will need to clearly communicate with providers to identify needs and then to make providers aware of payment changes through provider bulletins, webinars, provider associations, and other communication channels.