Centers for Medicare and Medicaid Services Administrator Seema Verma previewed on Tuesday a number of actions the agency plans to take in the coming months, including guidance on Medicaid block grants.

Verma, speaking at the National Association of Medicaid Directors fall conference in Washington, said the rising cost of Medicaid has increased the need for value-based care. She said that guidance allowing states more flexibility in Medicaid in exchange for capped federal funding is on the horizon. 

States like Tennessee and Utah have expressed an interest in pursuing such policies through federal waivers that would allow a Medicaid block grant or per capita cap system.

"We are encouraged by this interest. You will soon see guidance from us that lays out initial opportunities to test new approaches to delivering and financing care for certain optional adult populations," Verma said. 

She said the program, which will be known as the Medicaid Value and Accountability Demonstration, "won't compromise important beneficiary protections, but it will inject rigorous accountability for outcomes, provide significant and unprecedented flexibilities for program operation, and offer opportunities for shared savings that can be reinvested back into Medicaid."

She did not provide further details as when this guidance could be expected. Many state advocacy groups have pushed back on the idea of block grants, stressing that this could limit patients' access to care.

Verma also previewed a proposed program integrity rule that federal officials announced following her remarks. The rule would overhaul the structure of Medicaid payments to providers and require states to explain how they finance their share of supplemental payments.

Verma said that Acting Deputy Administrator and Director of the Center for Medicaid and CHIP Services Calder Lynch would provide more details on that proposed rule during his speech at the NAMD conference on Wednesday.

"We have seen a proliferation of payment arrangements that mask or circumvent the rules. Shady recycling schemes drive up taxpayer costs and pervert the system by shifting resources away from higher value settings," Verma said. "This rule will shine a light on these practices and help to set reasonable limits that even the playing field, addressing a source of government distortion and unfair competition in many markets."

Verma also highlighted other coming changes. She told attendees to watch for more guidance documents, including one to help support value-based payments in Medicaid through existing authorities. Another would help states address different social determinants of health such as problems consumers have in finding housing or transportation.

Verma said that CMS will announce annual auditing figures known as annual Payment Error Rate Measurement related to Medicaid and other programs "very soon."

She also defended current proposals such as Trump administration efforts to defend Medicaid work requirements in court. Federal officials have approved waivers allowing states to require Medicaid consumers to work, volunteer or participate in other programs in order to keep their coverage, but the program is not currently in effect anywhere because of legal challenges. 

The work requirements have been controversial, and four state approvals faced litigation. Verma said 10 more are still under review and that she "reject[s] the premise of the criticisms." She said that it's too early to tell what the long-term effects of the policy may be and problems that occurred when Arkansas implemented its program may not occur elsewhere. 

"Those with an axe to grind may wish to draw fatal conclusions from the early experiences of one state, but objective observers would do well to be more cautious," she said.