Medicaid Waiver Process To Be Eased With Web Applications - Thompson

The Centers for Medicare & Medicaid Services will develop web-based templates for Medicaid waiver applications and state plan amendments, HHS Secretary Thompson told the House Energy & Commerce/Health Subcommittee July 26.

The templates will "provide states with a clear, concise way to ensure they are providing all of the information the agency needs for a state to apply for, and operate, a waiver or state plan amendment under Medicaid," Thompson said.

Thompson advocates increased state flexibility on Medicaid issues as a means to expand health coverage to the uninsured. State Medicaid and Children's Health Insurance Program officials may request waivers and plan amendments from HHS to implement new approaches to operating their programs.

New Jersey, Rhode Island and Wisconsin received CHIP waivers Jan. 19 to expand Medicaid Rx coverage (¹ (Also see "Medicaid Rx Coverage Expands In Three States With CHIP Waivers" - Pink Sheet, 29 Jan, 2001.)).

CMS also will develop an interactive template to help state Medicaid officials learn about the effectiveness of previously implemented waivers, as well as tips on how to navigate the waiver process. In addition, the interactive template will allow state officials to work directly with CMS staff as they design their waivers.

In an April 26 letter to Thompson, Energy & Commerce Democrats asked HHS to publish on the Internet general information about ongoing projects that resulted from waivers. Under current law, HHS is not required to release any information regarding waivers.

Lawmakers expressed concern that the Administration was relying too heavily on waivers as a means of expanding coverage, and that existing beneficiaries might lose coverage in the effort to expand the base.

The letter asks Thompson to detail how vulnerable populations, such as patients with disabilities, mental illnesses, HIV/AIDS or substance abuse problems, would be affected by waiver programs, particularly those that require enrollment in managed care plans.

CMS also will attempt to expand state Medicaid programs by educating officials on how to optimize enrollment, Thompson told the subcommittee.

Waivers that expand access to Medicaid-priced drugs have been challenged by the drug industry. The Pharmaceutical Research & Manufacturers of America filed a lawsuit June 29 in D.C. federal court against a Maine discount program established through the Medicaid waiver process. The lawsuit also names as defendants HHS and CMS, which approved the Maine demonstration program in January.

"The question we're asking is whether the secretary of HHS will help defend that waiver even though it was issued by the prior Administration," Rep. Allen (D-Maine) said July 23 during a Public Citizen press briefing.

The Maine Congressional delegation (Sens. Snowe (R) and Collins (R), Reps. Baldacci (D) and Allen) wrote Thompson July 19 requesting support for the Healthy Maine Prescription Program.

"The demonstration component of this program...is entirely in keeping with the spirit of the provision in the Social Security Act granting the secretary of [HHS] the ability to grant waivers for demonstration projects, and should the project not be allowed to go forward, the department will lose potentially valuable information concerning the methods by which we may increase access to prescription drugs," the letter states.

Snowe introduced a bill (S 1177) July 12 that would give HHS the authority to grant Medicaid demonstration project waivers like those given to Maine and Vermont. New Hampshire has applied for a similar waiver.

The Healthy Maine Prescription Program has enrolled 60,000 low-income seniors since its launch June 1.

PhRMA has had success challenging Vermont's waiver program. A D.C. federal appeals court ruled June 8 that HHS did not have the authority to approve the Vermont Pharmacy Discount Program demonstration project (² (Also see "PhRMA v. HHS" - Pink Sheet, 11 Jun, 2001.)).

PhRMA is considering whether to take its case against another Maine drug discount program to the U.S. Supreme Court. The Maine Rx Program, created by state legislation, requires manufacturers to offer rebates on drugs sold to Maine residents who do not have prescription drug insurance (³ (Also see "Maine Rx Rebate Program Stayed As PhRMA Mulls Supreme Court Case" - Pink Sheet, 9 Jul, 2001.)).