The Centers for Medicare and Medicaid Services (CMS) has issued a draft of a regulation that could help state Medicaid programs show they are meeting patient care access requirements.
To meet the proposed standards, states might have to use commercial plan enrollee care access data from state databases, CMS databases, beneficiary surveys and other sources, CMS officials say in a Medicaid care access proposed rule that appears today in the Federal Register.
If implemented, the CMS proposed rule would have no direct effect on ordinary commercial health plans. The rule could affect commercial companies that manage state Medicaid plans, and the success or failure of Medicaid care access measurement efforts could affect the thinking of customers and plan managers in the commercial plan market.
CMS officials note that they want to offer state programs a high degree of flexibility to try new approaches to improving the quality of care and control the cost.
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“We recognize that payment reductions or other adjustments to payment rates are legitimate tools to manage Medicaid program costs and achieve overall budget objectives,” officials say. “However, payment rate changes made without consideration of the potential impact on access to care for Medicaid beneficiaries or without effective processes for assuring that the impact on access will be monitored, may lead to access problems. Payment rate changes are not in compliance with the Medicaid access requirements if they result in a denial of sufficient access to covered care and services.”
Medicaid is a public health program for the poor that is managed by the states and funded with a combination of state and federal money.
Section 1902(a)(30)(A) of the Social Security Act requires states to show that Medicare enrollees are