The proposal would exempt states with a Medicaid managed care penetration of 85% or more from some monitoring requirements, and provide flexibility to states when they make nominal rate reductions to fee-for-service payment rates.
A proposed rule change by the Centers for Medicare & Medicaid Services would exempt state Medicaid programs from some access-to-care reporting requirements.
Specifically, the proposal would exempt states with a Medicaid managed care penetration of 85% or more from some monitoring requirements, and provide similar flexibility to states when they make nominal rate reductions to fee-for-service payment rates.
"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," CMS Administrator Seema Verma said in a media release.
Under CMS's Notice of Proposed Rulemaking:
- States with an overall Medicaid managed care penetration rate of 85% or greater (currently, 17 states) would be exempt from most access monitoring requirements.
- Reductions to provider payments of less than 4% percent in overall service category spending during a state fiscal year (and 6% over two consecutive years) would not be subject to the specific access analysis.
- When states reduce Medicaid payment rates, they 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, which states have found very difficult to do.
Jeff M. Myers, president and CEO of Medicaid Health Plans of America, said the existing rules are not needed in states with a high penetration of Medicaid managed care plans because they already have robust provider networks.
"The exception lessens the burden on states and is in line with the overall effort to streamline some regulations and introduce more efficiency into the program," Myers said.
John Commins is a senior editor at HealthLeaders.