Medicaid Rule Would Ease Access-to-Care Monitoring Requirements

The Centers for Medicare & Medicaid Services today issued a proposed rule that would exempt states with an overall Medicaid managed care penetration rate of 85% or more from most access-to-care monitoring requirements, such as requirements to analyze certain data and monitor access in fee-for-service delivery systems. The rule also would provide similar exemptions to all states when reductions to provider fee-for-service rates are less than 4% of overall service category spending during a state fiscal year and 6% over two consecutive years. When reducing payment rates, states would rely on baseline information regarding access under current payment rates, rather than be required to predict the effects of rate reductions on access to care, CMS said. “These new policies do not mean that we aren’t interested in beneficiary access, but are intended to relieve unnecessary regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries,” said CMS Administrator Seema Verma. The proposed rule will be published in tomorrow’s Federal Register with comments accepted for 60 days. In other news, CMS today issued a final notice updating the Medicaid National Drug Rebate Agreement used by the Department of Health and Human Services and manufacturers to incorporate legislative and regulatory changes since the agreement was published in 1991.