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Association: Add Hospital Services to Medicaid Access Reviews

In Dec. 21 comments, America’s Essential Hospitals called on federal officials to include hospital services among services subject to triennial reviews under new requirements for states to determine whether Medicaid payments ensure adequate provider participation and, in turn, access to care.

Hospitals services were notably absent from a recently published equal access final rule that set the new requirements. In its comments to the Centers for Medicare & Medicaid Services (CMS), America’s Essential Hospitals strongly urged the agency to elevate hospital services to the automatic process proposed for other services subject to triennial access reviews.

CMS initially proposed requiring states to perform an access review for all Medicaid-covered services every five years. In the final rule, CMS increased the frequency of required reviews to every three years, but significantly limited the scope of service categories subject to review. Hospital services were conspicuous by their absence.

The association continued to stress the importance of access to hospital services in comments to a companion request for information (RFI). CMS released the RFI to obtain information on core access to care measures and metrics that the agency would apply to state reviews to further refine care access measurement and thresholds, as well as goals development.

CMS will accept comments on the final rule and RFI through Jan. 4, 2016. Questions? Contact Director of Policy Erin O’Malley at 202.585.0127 or eomalley@essentialhospitals.org.

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About the Author

Gontscharow is a senior policy analyst for America's Essential Hospitals.

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