CMS Gets Mixed Feedback on its Medicaid Access Monitoring Rule

Several stakeholders have submitted comments on a CMS rule that requires state Medicaid agencies to monitor how cuts to provider payment rates affect beneficiaries' access to care, Modern Healthcare reports (Dickson, Modern Healthcare, 1/6).

Background

CMS in 2011 released the initial proposed rule after states had suggested reducing provider reimbursements during the recent economic recession. CMS issued the final rule in November 2015 (Muchmore, Modern Healthcare, 10/29). Public comments on the rule were due Jan. 4 (Modern Healthcare, 1/6).

Rule Details

Under the rule, states will have to measure:

• Medicaid beneficiaries' access to care and providers;
• Beneficiaries' care needs; and
• Beneficiaries' use of health care services.

The states' assessments must take place beginning the first year of the payment reductions and then every three years.

Any state that discovers access issues would need to submit a correction plan within 90 days from when the problem was identified (Modern Healthcare, 10/29).

Comments

Providers in their comments generally supported the rule but called for additional measures to be monitored.

For example, the American Medical Association said, "The rule does not go far enough," adding, "We do not believe the rule provides sufficient criteria for measuring access and urge that it be strengthened by requiring states to use specific and uniform data elements." AMA said that states should have to track appointment wait times by provider type and beneficiaries' ability to access alternative office hours. In addition, AMA requested that CMS require states to conduct a comparison of Medicaid fee-for-service and Medicaid managed care payment rates.

Hospital associations criticized the rule for not requiring assessments of hospital services. The Arizona Hospital and Healthcare Association said the exclusion "will allow states to continue to cut funds for hospital services with little federal oversight, exacerbating access to lifesaving treatment and basic hospital services."

Meanwhile, state Medicaid agencies said they oppose the rule's creation of national standards for access to care. The Texas Health and Human Services Commission noted, "State Medicaid agencies are the experts on the Medicaid populations they serve and are in the best position to develop methodologies to ensure sufficient access to care" (Dickson, Modern Healthcare, 1/6).