March 15, 2024
I sent an email (pasted below) to many state leaders today after reading that CMS has taken steps to allow states to speed Medicaid reimbursement payments to providers affected by the Change Healthcare cyberattack.
According to Modern Healthcare, the flexibilities allow states to submit Medicaid state plan amendments so they can make interim payments to providers for services for which claims have not been submitted because of the outage. The payments can be retroactive to Feb. 21 for any claims affected by the incident at Change Healthcare, a claims and billing processor within UnitedHealth Group’s Optum subsidiary, CMS said in a news release.
As soon as the amendment form is submitted and approved, states will be able to use Federal Financial Participation funds, the agency said. The flexibility would only apply to affected providers and for services dates through June 30. The agency said it encouraged states to submit the required documentation by March 31.
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(note to Executive, DoB, OMH, OASAS, DFS, DOH leaders from Lauri/NYS Council today at 5:15)
Good afternoon,
I wanted to share with you the following information (below) I just received from our colleagues at the National Council for Mental Wellness (formerly the National Council for Community Behavioral Healthcare) in Washington, DC (see below). I made a call last week to the National Council’s CEO Chuck Ingoglia seeking assistance for mental health and substance use disorder providers across New York State as they continue to experience significant financial stress associated with the CHANGE Healthcare outage.
To this point, the United/Optum “temporary loan assistance’ fund has proven to be relatively useless. Agencies with gaping revenue holes from week to week are receiving pennies on the dollar from this “fund” and the HHS temporary assistance being offered is not directed at agencies serving high numbers of Medicaid care recipients.
We do not expect the Change Healthcare clearinghouse to be up and running for weeks. They say March 18 but what that actually means is that they will begin testing their systems to ensure they are operational on 3/18 or thereafter.
Providers are having real trouble hooking into alternative clearinghouses. We need concrete assistance.
As always, the NYS Council stands ready to assist you in any way.
Thank you.
Respectfully, Lauri Cole, Executive Director
NYS Council for Community Behavioral Healthcare
(518) 461-8200
New Information from CMS:
This afternoon, in response to the cyber attack on Change Healthcare, CMS announced important flexibilities to help state Medicaid agencies provide needed relief to Medicaid providers and protect access to care, particularly those in fee-for-service delivery systems. The new informational bulletin highlights existing and temporary flexibilities with a focus on providing states an expedited process for implementing interim payments to affected providers to mitigate disruptions.
You can see our new guidance here: https://www.medicaid.gov/sites/default/files/2024-03/cib031524.pdf
And the CMS statement here: https://www.cms.gov/newsroom/press-releases/statement-change-healthcare-non-enforcement-medicaid-informational-bulletin
Summary: This CIB outlines a framework under which CMS will permit states to expedite these interim payments to providers while maintaining key guardrails to protect program integrity. The interim payments that CMS would permit under this framework would be limited to no more than recent prior period (that produces the most accurate interim payment amounts) Medicaid payments for an equivalent service period on a provider [1] specific basis. The flexibility would only be available for affected providers, and for affected service periods through no later than June 30, 2024, and subject to reconciliation using actual individual service-specific data once states regain access to this data at the resolution of the cybersecurity incident. CMS will permit states to take advantage of this framework only if they develop and submit a Medicaid SPA, within timeframes described in this CIB and have CMS approval prior to June 30, 2024, to obtain authority to make payments in this manner until regular operations can resume.