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CMS Proposes to Rescind Medicaid Access Reviews

The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule rescinding the requirement that states develop and submit access monitoring review plans (AMRPs).

The AMRP requirement was set to ensure Medicaid fee-for-service (FFS) beneficiaries have access to health care services comparable to that of a given area’s general population. CMS proposes to rescind this requirement due to states’ concerns regarding undue administrative burden associated with conducting AMRPs.

If finalized, statute still will require states to ensure Medicaid payment rates are sufficient to enlist providers to assure beneficiary access to all Medicaid-covered services. Rather than conducting AMRPs, states that propose to reduce or restructure payment rates must submit information and analysis demonstrating compliance with the statutory beneficiary access requirements when filing state plan amendments for agency approval. CMS expects to issue subregulatory guidance outlining the information and data the agency will accept to demonstrate compliance.

The AMRP requirement was set in a 2015 final rule 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. Notably, hospital services were omitted from the access reviews.

CMS also issued a March 2018 proposed rule that would have provided an exemption from the 2015 requirements to states with a Medicaid managed care penetration rate of 85 percent or higher, as well as change the rate reduction threshold for access reviews. In the current proposed rule, CMS notes that the agency decided against finalizing this exemption in favor of rescinding the AMRP requirement for all states.

In addition to the proposed rule, CMS issued guidance to states to remind them of their ongoing statutory responsibilities to ensure appropriate access to care for beneficiaries.

America’s Essential Hospitals is analyzing the proposed rule and will provide written comments to CMS. The proposed rule will be published in the Federal Register on July 15, with comments due to the agency by Sept. 13.

Contact Senior Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

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

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