CMS issues final rule on access

CMS just released a final rule for the Methods for Assuring Access to Covered Medicaid Services, finalizing a proposed rule issued in 2011.

The final rule require state Medicaid agencies collect data to demonstrate access to care by examining enrollee needs, the availability of care and providers, and the utilization of services. Beneficiary experiences are to be a primary determinant of whether access is sufficient. While the rule includes guidelines for this review, it demurred on the issue of a core set of measures, indicating no measures received a consensus and were universally applicable. Rate reductions must be supported by a data review and public process, or may be rejected by CMS.

The final rule clearly indicated that the Supreme Court’s decision in Armstrong v. Exceptional Child Center, Inc., (2015), which found that Medicaid statute does not provide a private right of action in federal court to providers to challenge whether a state’s Medicaid program is designed to ensure sufficient provider participation to ensure access to care for beneficiaries, was not anticipated in the original 2011 proposed rule. This ruling indicated CMS is ultimately responsible for enforcing the statutory requirement that state’s Medicaid programs must be structured to ensure sufficient participation by providers to provide access to care for beneficiaries.

CMS made it clear more is to come on this topic, as they are concurrently issuing a request for information (RFI) soliciting feedback on core access measures, thresholds, and appeals processes to ensure access to care for Medicaid beneficiaries.

NRHA is pleased CMS is working to ensure Medicaid programs are structured to ensure access for the vulnerable rural Americans who rely on Medicaid for access to health care and will continue to review the final rule and the RFI to help ensure the rule will improve access to care for Medicaid beneficiaries in rural America.

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