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MMPC and TTAG Meetings Spotlight Disenrollment Data Sharing and Proposed Nursing Staff Requirements

From October 17 to October 19, the Centers for Medicare and Medicaid Services (CMS) Tribal Technical Advisory Group (TTAG) and the Medicare, Medicaid, and Health Care Reform Policy Committee (MMPC) held their face-to-face meetings in Crystal City, Virginia. These meetings gathered Tribal leaders, federal representatives, and Tribal health policy advocates engage on current priorities and issues. At the conclusion of both meetings, it is clear that significant work remains surrounding Medicaid unwinding disenrollments, the proposed rule on nursing staff requirements, and the new AHEAD Model Cooperative Agreement.

Navigating the challenges of Medicaid Unwinding continues to be a top priority for the TTAG. Alice Weiss, Deputy Director of Children and Adults Health Programs Group, shared updates on CMS’s compliance efforts with states. CMS distributed a letter on August 30, 2023 requesting states assess the accuracy of their Medicaid eligibility determinations for household dependents. Twenty-nine states responded reporting a risk of inappropriate disenrollments of this nature. TTAG technical advisors voiced additional concerns about American Indians and Alaska Natives (AI/ANs) losing Medicaid coverage, sharing data from the Kaiser Family Foundation Unwinding Tracker, which indicates up to seventy percent of disenrollments are because of procedural reasons, rather than a true lack of eligibility.

In addition to the issue of procedural disenrollments, there is a further challenge of obtaining data for the specific proportion of disenrollments that are AI/ANs. TTAG shared a request asking CMS require states to work with Indian Health Service, Tribal, and Urban health centers to share data on AI/AN enrollment. Ms. Weiss responded to this request saying that CMS and states often do not capture data on race and ethnicity demographics. CMS did show interest in pursuing the TTAG’s suggestion that they provide a basic data-sharing agreement template for Tribal use that could establish this relationship going forward. Additionally, Phoenix Alternate Representative, Angie Wilson, proposed that Nevada could create a secure line to share data which the state could use to issue monthly enrollment reports. Deputy Administrator and Director of Medicaid, Dan Tsai, was receptive to this idea, replying that it is possible that Nevada could demonstrate this model to other states.

Newly proposed nursing staff requirements were another major issue area coming out of the Face-to-Face meetings. In September, CMS published a proposed rule (88 FR 61352) that would require, “an RN to be on site 24 hours per day and 7 days per week” to “ensure safe and quality care” in long-term care (LTC) facilities. CMS LTC Policy Analyst and Lead Researcher, Captain Pauline Karikari-Martin indicated that in order to be exempt from this proposed requirement, facilities would have to demonstrate that they made a good faith effort to hire the required registered nurses, including making “competitive wage offerings.” TTAG Co-Chair Dr. Judy Parker replied to the presentation with the need for a blanket exemption for Tribes to this proposed rule, especially given that licensed practical nurses would not be considered to satisfy this requirement. CMS responded with an invitation to submit any concerns through written comment. Comments on this proposed rule will be accepted through November 6, 2023.

Center for Medicare and Medicaid Innovations (CMMI) Model Lead, Lauren McDevitt, presented on the States Advancing All-Payer Health Equity Approaches and Development (AHEAD) Model. The AHEAD Model has three main goals: “improve population health,” “advance health equity," and "curb healthcare cost growth." CMS plans to award up to eight Cooperative Agreement awards, potentially totaling $12 million each, to support the implementation of the model. TTAG Representative and Secretary Jim Roberts shared concerns that the AHEAD Model does not seem to consider AI/AN communities, and, therefore, cannot work for AI/AN communities. Mr. Roberts further encouraged CMS to conduct Tribal consultation on similar initiatives from their beginning. CMS responded stating that there is room to collaborate on AHEAD and that the model has capacity for flexibility.

The next TTAG Face-to-Face Meeting is tentatively scheduled for March 6-7, 2024, with the MMPC meeting preceding on March 5, 2024. If you are interested in becoming involved with MMPC, email Hannah Brennan, Senior Policy Analyst, at [email protected] for more information.

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