January 11, 2023

HHS Expands Access to Specialty Care for Medicaid Beneficiaries

The U.S. Department of Health and Human Services (HHS) Centers for Medicare and Medicaid Services (CMS) issued guidance Jan. 5, to create a more direct path to interprofessional consultation for Medicaid and CHIP (Children’s Health Insurance Program) beneficiaries.

The new policy eliminates the need for consulting providers to coordinate payment via separate agreements with the treating practitioner, giving Medicaid and CHIP programs the flexibility to develop payment methods to reimburse consulting practitioners directly for their services. This will expedite access to specialty care, especially because these consultations can occur when the beneficiary is not physically present. Additional information is provided in the HHS letter to the state programs.

If you have questions, contact Kimberly Greck, ACR Economic Policy Analyst.