On May 6, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule, “Methods for Assuring Access to Covered Medicaid Services.” The goal of the rule is to create a clear Medicaid rate setting process for states to ensure health quality for enrollees and a sufficient number of participating providers. Current law requires that Medicaid provider payment rates are (1) “consistent with efficiency, economy, and quality of care,” and (2) “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.” Although CMS has stated that the proposed rule’s criteria do not apply to Medicaid services provided through managed care, advocates contend that managed care should be included in the process. Because of budget constraints, some states have reduced Medicaid provider payments without considering whether Medicaid enrollees have sufficient access to care. Moreover, federal courts have inconsistently interpreted Medicaid provider rate requirements.
As a result, CMS issued the proposed rule to further clarify interpretation of current Medicaid law. Among other provisions, the proposed rule:
- requires states to establish a process for Medicaid enrollees to provide feedback on the sufficiency of the care that they receive;
- requests comment on available data sources to measure access to care for Medicaid enrollees and the general public; and
- requires states to assess the sufficiency of access to Medicaid services, at least once every five years.
Comments on the proposed rule must be received by July 5.
Those wishing to do so could submit comments supporting the need for a transparent process to protect access to Medicaid services and improve state budgetary processes.