Provider Payment And Access To Medicaid Services: A Summary of CMS’ May 6 Proposed Rule

This brief summarizes the major provisions of a rule proposed by the Centers for Medicare and Medicaid Services that would set forth state requirements for ensuring access to care in state Medicaid programs. It would apply to fee-for-service Medicaid, but not to Medicaid managed care programs. The public comment period for the regulation closed on July 5, 2011.

Under the proposed rule, state Medicaid agencies would have to review access to a subset of Medicaid-covered services every year, and review access to every Medicaid-covered service at least once every five years. If a state identifies access issues through its reviews or monitoring, it would have to submit a corrective action plan to CMS within 90 days. The proposed rule also would significantly change the process for reducing Medicaid payments to fee-for-service providers. State Medicaid agencies that seek to reduce Medicaid payment rates would have to submit to CMS along with a state plan amendment an access review for the service in question that has been completed within the last 12 months and which demonstrates sufficient access to care. The state Medicaid agency also would have to submit an analysis reflecting its consideration of beneficiary and stakeholder input on the impact of the proposed rate change on access to the affected service.

Issue Brief (.pdf)