CHA News

CMS Proposes Regulation to Alleviate State Burden

Rule would relax access to care monitoring requirements

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The Centers for Medicare & Medicaid Services (CMS) recently issued a proposed rule that would provide states with greater flexibility in how they meet access to care requirements within the Medicaid program.

The proposed rule addresses concerns associated with the 2015 final rule — which CHA commented on — that requires states proposing to reduce or restructure Medicaid fee-for-service payment rates to collect data through an Access Monitoring Review Plan and solicit input on the potential impact on beneficiaries’ access to care.

CMS proposes to exempt states with an overall Medicaid managed care penetration rate of 85 percent or greater from most fee-for-service access monitoring requirements; California’s current Medi-Cal managed care penetration rate is 80 percent.

In addition, every state that cuts Medicaid fee-for-service rates by up to 4 percent in one state fiscal year or up to 6 percent in two consecutive years would no longer be required to conduct analysis to determine if access to care would be harmed by the reductions. When reducing Medicaid payment rates, states would rely on baseline information about access under current payment rates, rather than be required to predict the effects of rate reductions on access to care.

The proposed rule does not change statutory responsibilities for states to ensure Medicaid members have access to services, but aims to provide regulatory relief to states. CHA is currently analyzing the impact of this proposed rule and will submit comments, which are due by 2 p.m. (PT) on May 22.