NHeLP Breaks Down the Crucial Provider Payment Regulation

On May 6, 2011, CMS issued a proposed regulation on the provider payment provision of the Medicaid Act, Social Security Act §1902(a)(30)(A).[1] The statute provides that Medicaid rates must be “consistent with efficiency, economy and quality of care” (the “EEQ” provision) and must be “sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area” (the “Equal Access” provision).  Understanding Section (30)(A), which has generated significant litigation in recent years, is crucial to any state advocate who wants to protect access to Medicaid services.

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