The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would provide exemptions from Medicaid access to care guidelines for states with high Medicaid managed care penetration, as well as change the rate reduction threshold for access reviews.
The proposed rule alters a 2015 final rule with comment period that directed states to ensure Medicaid fee for service beneficiaries have access to health care services comparable to those of a given area’s general population. The rule included new requirements for access review, notice, and feedback when rates are changed for certain services.
CMS would exempt from the 2015 requirements state with a Medicaid managed care penetration rate of 85 percent or higher. Seventeen states currently meet the requirements for exemption under the proposed rule.
In addition, the proposed rule would remove access analysis requirements for provider payment reductions below certain thresholds. CMS proposes to provide an exemption from the access review requirements for states that submit state plan amendments (SPAs) to reduce rates or restructure payments in which the reduction is 4percent or less of overall spending in a state fiscal year (SFY) or 6 percent over two consecutive SFYs. For SPAs that reduce or restructure Medicaid payment rates, CMS proposes states submit an access assurance to the agency, rather than submitting an analysis that predicts the effects of the rate reductions on access to care.
The proposed rule aims to reduce regulatory burden on states and follows a November 2017 letter to state Medicaid directors that provided guidance on implementing access requirements.
America’s Essential Hospitals is analyzing the proposed rule and will provide written comment to CMS. Comments are due to the agency by May 22.
Contact Senior Director of Policy Erin O’Malley at firstname.lastname@example.org or 202.585.0127 with questions.