CMS wants to know if you have Medicaid concerns!
Thursday, February 04, 2016
Posted by: Kelly Shaw
CMS Meeting in response to letter from AABC, NACPM and ACNM about Medicaid MCO problems
AABC, ACNM and NACPM representatives met with a large group of CMS Medicaid and Finance leaders on January 28, 2016 at the Health and Human Services Building in Washington, DC. The meeting was directed by Tim Hill, Deputy Center Director, Center for Medicaid and CHIP Services (CMCS), and Ellen Marie Whelan, NP, PhD, FAAN – Senior Advisor, Center for Medicare and Medicaid Innovation (CMMI) (advisor to Strong Start Initiative). The meeting was requested in a letter sent to CMS in 2015, in which the three organizations representing birth centers and midwives joined in an effort to address problems with Medicaid reimbursement in birth centers.
At the end of October, AABC received a response from CMS to the joint letter request. The response acknowledged concerns about lack of full implementation of the Medicaid reimbursement of birth centers. The letter stated that “CMS requires the inclusion of a FBC (freestanding birth center) in the network of at least one managed care plan available to each beneficiary.” A contact at CMS was offered to discuss issues further.
AABC, NACPM and ACNM scheduled a meeting for January 28, 2016. In preparation for the meeting, AABC and the other organizations put together a set of slides to make the case for birth center outcomes, client satisfaction and cost savings. AABC also collected from birth centers a few specific examples of Medicaid MCO contracting or reimbursement problems that were presented at the CMS meeting. These issues included:
- Denial of contract because “similar services” are provided at local hospital
- Refusal to renegotiate existing contract when costs change
- Denial of professional services payment to licensed midwives
- Delay of reimbursement for 6-12 months
- Contracting declined because birth center cannot obtain transfer agreement with local hospital
- Large networks or IPAs have all the contracts and MCOs refuse to work with smaller, independent providers.
If your birth center is currently experiencing problems with Medicaid or Medicaid MCOs contracting or payment, please complete this survey or contact Jill Alliman, chair of the AABC Government Affairs Committee (formerly Legislative Committee) at email@example.com with details, the name of MCO and any pertinent correspondence.