CMS must issue a decision on three proposed Medicaid plans in Texas by March 25 or face big consequences.
A court ruling filed March 11 in the U.S. District Court for the Eastern District of Texas says the federal agency could face sanctions if a ruling is not issued within two weeks.
The court order stems from legal disputes between Texas and CMS over how to administer the state’s Medicaid programs. Texas has argued that CMS has been slow to issue decisions on five proposed state plans, though two plans have been approved.
According to the lawsuit, the delayed ruling is because CMS "believes that an arrangement among private hospitals creates a prohibited 'hold-harmless' guarantee, which requires CMS to withhold federal funding."
Three proposed state-directed payment programs are still in question:
- Rural Access to Primary and Preventative Services
- Texas Incentives for Physician and Professional Services
- Comprehensive Hospital Increased Reimbursement Program
Texas is hoping to keep a previously approved 10-year extension of special Medicaid rules and argues that the CMS position regarding private hospitals is "unreasonable."
The Texas judge declined to take a position on the legal dispute between Texas and CMS, but said a final decision must still be made.
"The court takes no position at this juncture on whether CMS's final decision should deny approval of the SDPs, approve the SDPs unconditionally, or approve the SDPs while reserving the prospect of future disallowment proceedings despite the large size of the SDPs. But the time is ripe, under the special terms and conditions that CMS has been enjoined to follow, for CMS to issue a final decision on the SDPs," said Judge J. Campbell Barker.