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CMS Rule Change Would Ease State Reporting on Medicaid Access

By John Commins  
   March 27, 2018

Jack Rollins, senior policy analyst at the National Association of Medicaid Directors, said the proposed rule change appears to address some concerns raised by the states.

"We are still reviewing but our preliminary impression, the caveat that we haven't had a conversation with our members, is that CMS appears to have taken state feedback into consideration and are making what looks to be some positive changes that will allow states to manage their programs effectively and still strike the balance between ensuring appropriate access and setting some guardrails around it without causing so much administrative complexity," Rollins said. 

Rollins said the proposed rule change amends an Obama administration rule that established a Medicaid access monitoring for fee-for-service programs, but exempted managed care.

"What that rule did was identify a bucket of five or six core service areas where states needed to put together data packages that showed how their rates compared to other payers in the state and nationally," Rollins said. "They would compare their rates to what Medicare paid, what other state Medicaid programs paid, maybe some commercial payers in the private market paid. The intent behind that was to look at the comparison and show that Medicaid rates aligned or were relatively close to other payers, or maybe they were far off."


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In addition to monitoring these core service areas, the rule also required states that were making rate reductions or restructurings in other services areas to produce an access monitoring plan to assess the impact on the rate change over three years, and to provide upfront projections on how the rate change would affect access.

"Our members took issues with some of that regulatory frame work," Rollins said. "The fact that it applied to fee-for-service and not managed care, when managed care programs are the primary delivery system for Medicaid these days."

"Many states might have the majority of their Medicaid populations covered under managed care and only a relatively small or vestigial fee-for-service," he said. "Those states felt it didn't make a lot of sense to invest a lot of time and staff resources and state dollars creating a comprehensive access monitoring plan for a program that in some states covered maybe 100 people."

In addition, providing state-by-state comparisons proved challenging.

"First of all, many states said they had trouble accessing any kind of private pay rates from Managed care plans in the private market. Understandingly, that information is proprietary," Rollins said.

John Commins is a senior editor at HealthLeaders.


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