CMS finalizes rules to improve Medicaid, CHIP access and payment

The Centers for Medicare & Medicaid Services April 22 finalized rules intended to improve access in both the Medicaid fee-for-service and managed care programs. The rules also align requirements in the Children’s Health Insurance Program with the Medicaid program and finalize several changes to state directed payments, including codifying state flexibility for directed payments to match the average commercial rate. 

In a statement shared with the media, Ashley Thompson, AHA’s senior vice president for public policy analysis and development, said, “Today’s final rule from CMS takes a number of important steps toward ensuring access and coverage for those eligible for Medicaid and CHIP, which are key priorities for America’s hospitals and health systems.

“The AHA appreciates that CMS acknowledges the critical role hospitals play in state Medicaid financing and the importance of supplemental payments to sustain beneficiary access to care in light of low Medicaid base payment rates, including rates paid through managed care organizations. In particular, we applaud CMS’ recognition that hospitals treat all patients the same — regardless of coverage — by formally adopting the average commercial rate as the upper payment limit as advocated by the AHA. Codifying this provision ensures that hospitals have appropriate resources to serve Medicaid patients and strengthen America’s safety-net. The AHA also appreciates CMS’ efforts to streamline the approval of certain existing arrangements, which will cut down on bureaucracy and burden and allow hospitals to focus on their patients.

“Additionally, we thank CMS for listening to our concerns by delaying enforcement of the attestation provision as the various courts evaluate this issue. Though we remain concerned that the policy could result in financing restrictions that could have consequences for patient coverage and access, we appreciate the agency is preventing any confusion and unnecessary burden that could result from implementing the policy before these legal processes finish.

“Finally, the AHA applauds CMS’ efforts to strengthen network adequacy requirements and oversight. The finalized provisions represent common sense approaches to ensuring Medicaid beneficiaries enrolled in a managed care health plan can access the services they need. We look forward to continuing to work with CMS, states, and other stakeholders as they seek to implement new network adequacy standards.”