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  • Washington Highlights

    CMS Issues Guidance on Medicaid Interim Payments for Change Healthcare Disruptions


    Shahid Zaman, Director, Hospital Payment Policy
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin allowing state Medicaid agencies that submit state plan amendments to receive federal financial participation (FFP) for making interim payments to providers who are affected by claims submission disruptions related to the Change Healthcare cyberattack. These payments will be calculated at the provider-specific level based on historical payment amounts and will be available for service periods starting when the provider began to experience claims disruptions through June 30. Once actual claims data becomes available for providers for the affected periods, the state Medicaid agency will reconcile the interim payment amounts with final payment amounts and settle any provider underpayments or overpayments. The CMS also is extending states the option of waiving cost-sharing requirements for Medicaid beneficiaries until June 30.   

    To qualify for FFP related to the interim payments, a state Medicaid agency must submit a state plan amendment (SPA) outlining its methodology for making these interim payments. The CMS is asking states to submit these SPAs by March 31. To expedite the availability of FFP for the interim payments, the CMS is relaxing some of the usual requirements for SPA approval. For example, the agency says that while the public notice requirement must still be met, a state can satisfy the public notice requirement after submitting the SPA to the CMS. The agency provides template language in the informational bulletin that states can use in their SPAs.