Subcommittee signs off on CMS model for value‑based payments for cell and gene therapies and a technical MAT update

The Rules Subcommittee approved two Medicaid‑related rule updates from the Department of Human Services' Division of Medical Services.

Elizabeth Pittman, director of DHS' Division of Medical Services, said the first rule adopts a CMS model that allows the state to enter value‑based payment arrangements with manufacturers of high‑cost cell and gene therapies for sickle cell disease. "These are two very expensive drugs that we are required to cover under Medicaid," Pittman said, and the model lets manufacturers rebate the state based on outcomes in exchange for participation in outcome‑tied payment arrangements.

Pittman said the second rule is an administrative update requested by CMS that removes an expiration date from federal guidance on medication‑assisted treatment and places state plan pages on a new template. She emphasized the change "does not change our coverage in any way" and that it is cost neutral. Both rules were presented with no public comment and were approved by the subcommittee without objection.

Why it matters: the value‑based payment authority is intended to give the state tools to manage the cost and outcomes of expensive single‑course therapies for conditions such as sickle cell disease; the MAT change preserves existing coverage while aligning the state's documentation with federal templates.

Next steps: Pittman said the cell and gene therapy model arrangements are proceeding through CMS review; the subcommittee approved both rules without objection.