Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • Sign Up Free
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Digital Health Transformation Summit
    • ESG: The Implementation Imperative Summit
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain
    • - Hospital at Home
    • - Workplace of the Future
    • - Digital Health
    • - Future of Staffing
    • - Hospital of the Future (Fall)
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • Data Center
    • Data Center Home
    • Hospital Financials
    • Staffing & Compensation
    • Quality & Safety
    • Mergers & Acquisitions
    • Data Archive
    • Resource Guide: By the Numbers
    • Surveys
    • Data Points
  • MORE +
    • Contact Us
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
July 08, 2015 01:00 AM

CMS fights claims that waiver process is corrupt and opaque

Virgil Dickson
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    At a congressional hearing Wednesday, CMS officials countered claims that favoritism plays a role when reviewing and approving Medicaid demonstration waivers and that the entire process is opaque.

    The House Energy and Commerce Committee's Subcommittee on Health hearing on Wednesday occurred two weeks after the CMS skipped a June hearing related to assertions of inconsistent oversight of Section 1115 demonstrations.

    Claims of favoritism were reiterated Wednesday during a hearing that was scheduled to commemorate the 50th anniversary of Medicaid's founding.

    “It's well known that some states get CMS approval for a specific proposal, while the CMS will deny another state for a very similar proposal,“ said Rep. Joe Pitts (R-Pa.), chairman of the subcommittee.

    CMS Medicaid Chief Vikki Wachino disagreed with the characterization. “We approach that process consistently across the states,” she said. She later added that specific state circumstances also play a part in the agency's decisionmaking.

    In fiscal 2011, Section 1115 demonstrations accounted for about one-fifth of Medicaid expenditures, rising to nearly one-third of total federal Medicaid expenditures in fiscal 2014, an estimated $89 billion in federal funds.

    The waivers allow states to experiment in their Medicaid programs to improve services to beneficiaries. Waivers must be budget-neutral, meaning the CMS is spending the same amount of money on a state that it would have spent without a waiver.

    The GAO has issued multiple reports going back into the 1990s in which it noted that the CMS process for approving state spending for demonstrations is opaque and doesn't ensure that demonstrations will be budget-neutral.

    Another key issue during Wednesday's hearing was the speed in which the CMS reviews waiver requests, even renewal applications for initiatives proven to work. Lawmakers say it's unfair to states that work under strict submission deadlines.

    “The CMS doesn't hold themselves to this same standard and it takes forever to get an answer,” Rep. Marsha Blackburn (R-Tenn.) said.

    Wachino responded that the agency is working toward streamlining the review process, but didn't provide specifics.

    In the past year, the CMS has stepped up its transparency efforts around 1115 decisionmaking, Wachino added.

    A key part of this strategy has been more clearly stating rational for approving waivers in documents posted on Medicaid.gov.

    Wachino also said several new policies are aimed to improve application review and ensure transparency.

    Lawmakers found it puzzling they were just hearing this, and when asked her thoughts, Katherine Iritani, director of healthcare at the GAO, said she had not seen these new policies but committed to doing so and following up on her thoughts with Congress at a later date.

    Members of Congress also appeared to be thrown by Wachino's response to how the CMS ensures the demonstrations are budget neutral.

    The GAO has claimed there are numerous cases in which states overspent by billions. For example, in 2013 and 2014, five demonstrations reviewed by the agency spent $33 billion more than what documentation would have supported.

    Wachino said the CMS has improved monitoring of the issue and noted there is a posted template to help states prove neutrality.

    “You can put all this stuff out there, but it's not a strong enough signal, we've proved its not working,” said Rep. John Shimkus (R-Ill.).

    The lawmaker added that he has drafted legislation that would require CMS' actuaries to personally sign off on the neutrality of waivers.

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Biden COVID_i.jpg
    Biden to end COVID emergency declarations on May 11
    WHO_i.jpg
    COVID-19 still an emergency but approaching 'inflexion point,' WHO says
    Most Popular
    1
    More healthcare organizations at risk of credit default, Moody's says
    2
    Centene fills out senior executive team with new president, COO
    3
    SCAN, CareOregon plan to merge into the HealthRight Group
    4
    Blue Cross Blue Shield of Michigan unveils big push that lets physicians take on risk, reap rewards
    5
    Bright Health weighs reverse stock split as delisting looms
    Sponsored Content
    Modern Healthcare Alert: Sign up for this breaking news email to be kept in the loop as urgent healthcare business news unfolds.
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2023. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain
        • - Hospital at Home
        • - Workplace of the Future
        • - Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • Data Center
      • Data Center Home
      • Hospital Financials
      • Staffing & Compensation
      • Quality & Safety
      • Mergers & Acquisitions
      • Data Archive
      • Resource Guide: By the Numbers
      • Surveys
      • Data Points
    • MORE +
      • Contact Us
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing