HHS/CMS: New Secretary, Medicaid Work Requirements & Community Rule Adjustments
Pharmaceutical Executive Named New HHS Secretary
WASHINGTON — President Trump has nominated a pharmaceutical executive to be the next secretary of the Health and Human Services Department.
 
The nominee, Alex M. Azar II, served as a deputy at the department under former President George W. Bush. Until January, he was the head of the pharmaceutical company Eli Lilly’s United States division.
 
Mr. Trump made his announcement in a Twitter post while traveling in Asia. Mr. Trump said Mr. Azar would be “a star and lower drug prices
 
Mr. Azar worked for Eli Lilly for a decade, from 2007 to 2017, and in 2011 became president of the company’s United States division.

States To Determine Meaning of Isolation
Representatives of the Centers for Medicare and Medicaid Services, speaking last week at the 2017 Annual Conference of the National Association of State Directors of Developmental Disabilities Services (NASDDDS), told state directors that the CMS will continue to seek state compliance with the Home and Community Based Services Rule on Community Settings, but expect to give more discretion to individual states to determine whether residential or employment sites are considered isolating.

In the 2014 Community Settings Rule, promulgated during the Obama Administration, states were expected to adhere to meet certain standards that for the first time articulated the definition of community, with respect to Home and Community Based Services. Under the Community Settings Rule, both residential and employment services were expected to provide participants with increased inclusive settings. States were directed by CMS to develop State Transition Plans that would assure program compliance by March 2019, later extended by CMS to March 2022. States were asked to report to CMS the degree of existing compliance within each state, and identify how the state would achieve full compliance to assure that HCBS programs met the rule. For sheltered workshops and congregate residential sites, the HCBS regulations were expected to be the most challenging, though CMS had been clear that it considered inclusion to be in the aggregate for an individual and not merely based on a single aspect of the participant's life.

Last week, CMS Community Settings Reviewer Melissa Harris indicated that the new Trump Administration, in addition to giving states more time to comply with the Settings Rule, would also look to the states to provide their own interpretation and determination of what constitutes an isolated setting. While Harris suggested this development should not be interpreted as a weakening of the Settings Rule, she did acknowledge that standards and interpretations may have some variance from state to state; an interpretation many would not have expected from the previous Obama Administration.

Pennsylvania participants at the NASDDDS conference included ODP Deputy Secretary Nancy Thaler (the former executive director of NASDDDS) and PAR Vice President Gary Blumenthal.
CMS Says Yes to MEDICAID Work Requirements
(PAR Editor's note: Verma's proposed Medicaid work requirement is not expected to be applied to individuals with disabilities. ANCOR and PAR will monitor proposed CMS regulations. PAR is reporting on this development noting the potential for collateral impact on disability programs)

WASHINGTON — The Trump administration announced on Tuesday what it called “a new day for Medicaid,” telling state health officials that the federal government would be more receptive to work requirements and other conservative policy ideas to reshape the main government health program for low-income people.

Seema Verma, the administrator of the Centers for Medicare and Medicaid Services, said the administration would approve proposals from states to require work or community engagement for people who want to receive Medicaid. The Obama administration had turned down such proposals, saying they would not further the purposes of Medicaid, which are to promote health coverage and access to care.

But in a half-hour speech to the National Association of Medicaid Directors, which represents state officials, Ms. Verma said on Tuesday that Medicaid had a higher purpose: to help people “rise out of poverty and government dependence.”

Many people on Medicaid, including many who became eligible as a result of the Affordable Care Act, are able-bodied adults of working age, Ms. Verma said.

“These are individuals who are physically capable of being actively engaged in their communities, whether it be through working, volunteering, going to school or obtaining job training,” Ms. Verma said. “Let me be clear to everyone in this room: We will approve proposals that promote community engagement activities.”