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PROPOSED RULES WOULD HELP STATES EVALUATE MEDICAID BENEFICIARY ACCESS TO CARE

PROPOSED RULES WOULD HELP STATES EVALUATE MEDICAID BENEFICIARY ACCESS TO CARE

The Centers for Medicare & Medicaid Services (CMS) today issued a proposed regulation that would provide guidance to States on ways to ensure that people with Medicaid have access to health care services.

Federal law requires that Medicaid provider payment rates be consistent with “efficiency and economy” and set at levels sufficient to assure people with Medicaid have the same access to health care services as people with other types of health insurance.  Tight State budgets coupled with increased demand for services during the recession have led many States to propose reductions in Medicaid provider payments, without clear Federal guidance on how to assure access.

The rules proposed today rely on the research and recommendations of the Medicaid and CHIP Payment and Access Commission (MACPAC).  They will ultimately help States determine how and where they can achieve savings without impeding access by providing options for States to use to measure and assess access to care.

“The proposed rule does not set a national standard or mandate any particular payment level,” said Cindy Mann, director of the CMS Center for Medicaid, CHIP, and Survey & Certification.  “Rather, it proposes a standardized, transparent process for States to ensure that the millions of pregnant women, children, seniors, and people with disabilities that they cover in Medicaid have access to the care they need.”

Today’s regulation proposes that States conduct periodic reviews of data for all covered services using a three-part framework recommended by MACPAC:  (1) enrollee needs; (2) the availability of care and providers; and (3) utilization of services.   The rule proposes that States should first determine whether patients’ needs are being met, and proposes a range of data that states could use to evaluate the sufficiency of access to care.

The proposed rule also ensures transparency by requiring that States publish the results of the reviews annually and requires public comment before any changes to a payment methodology or rate.     

           The proposal went on display today at the Federal Register and can be viewed at

http://www.ofr.gov/OFRUpload/OFRData/2011-10681_PI.pdf   or  http://www.federalregister.gov/inspection.aspx.  

The proposed regulation will publish in the Register on May 6 and public comments will be accepted until July 5, 2011.