July 17, 2019

CMS Proposes New Rule to Monitor Medicaid Rates and Provider Access

On July 11, 2019, the Centers for Medicare and Medicaid Services (CMS) released Medicaid Program; Methods for Assuring Access to Covered Medicaid Services – Rescission, a proposed rule that would replace a 2015 Obama-Era policy that helps determine if fee-for-service (FFS) Medicaid payment rates are high enough to attract physicians and other providers to assure health care access for the program’s beneficiaries.

The current policy requires state governments to develop, submit and then provide updates every three years for an access monitoring review plan (AMRP) for their FFS Medicaid programs. The plan reports on access to radiology, along with other physician specialist services, as well as primary care, behavioral health, obstetrical services, home health and other forms of medical care. Data collected for the AMRP must be assessed by CMS and made available for public comment whenever a state files for a state plan amendment (SPA) that proposes Medicaid rate reductions or restructuring.

CMS Administrator Seema Verma said the agency’s proposed rule would streamline federal oversight of access-to-care requirements for Medicaid beneficiaries and would free state Medicaid agencies from unnecessary administrative burden.

If the proposed rule is finalized, CMS will replace current AMRP requirements, including the monitoring review procedures that must be followed before submission of SPAs that propose to reduce or restructure Medicaid payment rates. CMS plans to replace them with a more comprehensive and outcomes-driven approach to monitor access across delivery systems. The agency said the new comprehensive method would be developed through workgroups and technical expert panels that include key state and federal stakeholders.

In response, some stakeholders have raised concerns that the proposed rule will make it difficult to determine whether there are an adequate number of physicians and providers. States would still be required to maintain documentation of payment rates, but CMS will issue sub-regulatory guidance on the types of data that states may use to demonstrate if those rates are sufficient to encourage providers to serve Medicaid patients.

CMS expects the guidance would remind states of their ongoing obligation to ensure sufficient payment. They would be required to demonstrate with information provided through their SPAs that their proposed rates or rate structures satisfies statutory requirements.

The proposal is subject to a 60-day public comment period that began July 15. For more information, contact Christina Berry, ACR economic policy analyst.