CHA News

CMS Issues Proposed Rules on Medicaid Access and Payment Rates

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The Centers for Medicare & Medicaid Services (CMS) has issued two proposed rules related to Medicaid programs. The proposed rules are designed to improve access to care, quality, and health outcomes, and better promote health equity for Medicaid beneficiaries across fee-for-service and managed care delivery systems. Comments on both proposed rules are due to CMS by 2 p.m. (PT) on July 3.  

The proposed rule  on access to Medicaid services (Ensuring Access to Medicaid Services) targets payment rate transparency. CMS proposes that states make all fee-for-service (FFS) Medicaid payment rates public and accessible on a state website. States would also have to report their state Medicaid rates relative to Medicare FFS rates. CMS would establish an advisory group of beneficiaries, providers, and other interested stakeholders to advise on current or proposed payment rates. CMS also proposes several policies for home and community-based services.  

In the proposed rule  on managed care (Managed Care Access, Finance, and Quality), CMS seeks to establish national maximum appointment wait time standards for routine primary care for Medicaid and Children’s Health Insurance Program managed care beneficiaries. States would be required to conduct annual secret shopper surveys to ensure managed care plans comply with the wait time standards. States would also have to submit an annual payment analysis comparing managed care plan payment rates for certain services as a relative to Medicare’s payment rate. 

Additional information is available in a CMS fact sheet. CHA is reviewing both regulations and will provide summaries in the coming weeks.