The Centers for Medicare & Medicaid Services (CMS) has proposed rescinding current procedural standards that must be met for states to demonstrate that Medicaid fee-for-service (FFS) payments are sufficient to assure beneficiary access to covered services.
As we previously reported, regulations adopted in 2015 require states to establish and periodically update access monitoring review plans (AMRPs) for certain categories of Medicaid services provided through a FFS delivery system to demonstrate the sufficiency of provider payment rates. The regulations also include administrative requirements for states proposing to reduce or restructure Medicaid provider payments. These regulations apply to the following categories of services: primary care; physician specialist services; behavioral health; pre- and post-natal obstetric services including labor and delivery; home health; any services for which the state has submitted a state plan amendment to reduce or restructure provider payments that could result in diminished access; and additional services as determined necessary by the state or CMS.
Citing state concerns about the administrative burden associated with the current regulations, in March 2018 CMS proposed exempting states with high rates of Medicaid managed care enrollment from the AMRP requirements. CMS did not finalize this plan. Instead, in a proposed rule published July 15, 2019, CMS now proposes to rescind the regulatory process requirements for states to develop and update an AMRP and to submit certain access analysis when proposing to reduce or restructure provider payment rates. However, states would not be exempt from the statutory requirements "to ensure access is consistent with the Act generally, and especially when seeking to reduce or restructure Medicaid payment rates." CMS will accept comments on the proposed rule until September 13, 2019.
Concurrent with release of the proposed rule, CMS issued an informational bulletin to states announcing CMS plans "to develop a new data-driven strategy to understand access to care in the Medicaid program across fee-for-service and managed care delivery systems, as well as in home and community-based services (HCBS) waiver programs." In the coming months, CMS expects to convene workgroups comprised of state and federal stakeholders to identify measures, benchmarks, and data that could be used as access indicators across Medicaid programs.
This article is presented for informational purposes only and is not intended to constitute legal advice.