In March of 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would exempt states with at least 85 percent of their Medicaid managed care population from most access-monitoring requirements for services provided through the traditional fee-for-service avenue. This would immediately exempt at least 17 states from existing access monitoring requirements, and could also exempt another dozen states whose managed-care enrollment is close to the threshold.
Currently, states are required to analyze, document and report to CMS the impact of Medicaid fee-for-service payment amounts on beneficiary access to covered care services. Many medical providers and organizations, including the Association of American Medical Colleges, the Federation of American Hospitals and the National Council for Behavioral Health, are concerned that exempting states from the access monitoring process will result in reduced access for Medicaid beneficiaries.
Monitoring remains important, particularly as greater numbers move over to managed care, as it ensures the most medically fragile patients will continue to have access. Delays in accessing necessary treatment may lead to poorer outcomes and unnecessary costs to the medical system. The federal government created these access monitoring requirements to provide oversight to the Medicaid program and to be certain that it is providing its enrollees with access to high-quality care. Under this rule, states must demonstrate adequate access to care for Medicaid beneficiaries through important reporting and documentation requirements.
The rule also provides federal oversight of key factors that influence treatment access, such as provider payment rates set by state Medicaid programs. Proposed changes to the access rule would weaken or even eliminate certain reporting and documentation requirements for states in their Medicaid populations.
Under the proposed new rule, payment reductions of less than 4% during a state fiscal year, or 6% over two consecutive years, would not be subject to access monitoring analysis. CMS also wants to exempt states from seeking public input before making rate changes.
The Federation of American Hospitals warns that this would mean states could implement a 12% rate reduction over a span of four years without monitoring the impact of such significant rate changes.
The American Academy of Family Physicians writes that they oppose the proposal because it will “almost certainly lower the level of access monitoring in those states … Since this proposed rule impedes the federal government from confirming compliance with access to care for patients enrolled in Medicaid, the AAFP cannot support it.”
A number of California hospital groups have also expressed opposition to exemption from the access standards. “Such an exemption eliminates safeguards that were put in place under the current rule to promote a more transparent data-driven process for states to document whether Medicaid payments are sufficient to enlist providers to assure beneficiary access to covered services,” they write.
On the whole, most medical organizations fear the proposed changes will substantially weaken the effectiveness of the current regulations and will certainly undermine the intent of the statute. Revisions to current regulation should be to strengthen access, not weaken it.
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