America’s Essential Hospitals commented on the Centers for Medicare & Medicaid Services’ (CMS’) Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) request for information. CMS requested feedback on potential regulatory changes to address fraud in health care, specifically highlighting Medicaid payments and financing.
The association supports targeted, risk-based program integrity approaches that move away from burdensome “pay and chase” enforcement models. We urged CMS to:
- Focus program integrity efforts on removing bad actors and avoid adding unnecessary administrative burdens on compliant providers of care
- Establish program integrity efforts that do not interfere with states’ ability to develop legitimate Medicaid payment and financing policies that support safety net providers and advance Medicaid program goals
- Explore ways to streamline existing oversight of Medicaid supplemental payments and financing to reduce delays in payment and retrospective reconsiderations of long-standing payment policies
- Allow continued use of separate payment terms to provide transparency and accountability for state directed payments in Medicaid managed care
- Ensure compliance with states’ statutory obligation for rates sufficient to ensure equitable access for Medicaid patients by adding inpatient and outpatient hospital services and inpatient behavioral health services to state rates studies
- Monitor AI efforts to ensure AI is used appropriately to support access to care
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions or for more information.
Author