The CMS released a final proposed rule (PDF) Thursday requiring Medicaid agencies to monitor access to care for beneficiaries, particularly when a physician rate payment reduction is sought.
The rule was first proposed in May 2011 as a response to states' proposing the reduction of provider payments after the recession slashed their budgets.
States would be required to measure enrollee needs, availability of care and providers, and use of services every three years and within a year of implementing a provider payment reduction.
Any state that finds access issues would have to submit a correction plan within 90 days after discovering a problem.
Matt Salo, executive director of the National Association of Medicaid Directors, said his team is still evaluating the bill and getting feedback from members. He's trying to determine whether the demands on states are reasonable or unworkable, he said.
“There appear to be broad parameters on what type of rate change requires a major justification. Something that 'impacts access' is a pretty nebulous standard that will clearly need to be much more explicitly defined, or at least explicitly given to the states to determine,” he said.
The CMS clearly sees a need to step up its oversight of the rates, particularly after the U.S. Supreme Court decision in March ruling that private healthcare providers cannot sue Medicaid agencies over low payment rates, he said.
Dr. Wanda Filer, president of the American Academy of Family Physicians, said she is glad to see a final rule, and her organization is still reviewing it to see whether it will offer more public comment.
Filer said she supports the rule's efforts at transparency. She hopes they will allow all stakeholders to see what level physician payments should reach to be more equal with private insurance payments. She has traveled to many states where doctors tell her they struggle to continue to accept Medicaid patients.
“For some of those states, it is a real hardship for patients and primary care in particular,” she said.
Dr. Bruce Siegel, CEO of America's Essential Hospitals, said the rule is an important step forward for ensuring access but it has a major flaw.
“We're surprised and deeply disappointed that hospitals have been excluded from the list of service categories for which states would monitor access,” he said. “Hospitals that serve many Medicaid patients—essential hospitals—provide a lifeline for vulnerable people. We must ensure payment policies do not create obstacles to their care.”
The rule would go into effect in January and public comments will still be accepted until then.
