Healthcare stakeholders say a new federal policy mandating that health plans provide patients an adequate number of provider options may not significantly improve access for Medicaid beneficiaries. They say the policy doesn't address the problem of recruiting and retaining providers to treat Medicaid patients.
In April, the CMS finalized a mega managed Medicaid rule that meant to strengthen current regulations regarding network adequacy. The rule required states contracting with plans to develop and enforce minimum time and distance standards for providers. States would be in charge of determining those standards.
The new contracts between states and plans must be in effect by July 1, 2018.
Stakeholders say even with the new network adequacy standards, it's challenging to attract and retain providers.
For instance in Texas, the state already mandates a primary-care doctor shouldn't be any more than 30 miles from a Medicaid enrollee. However, specialists, which tend to be more elusive for patients, could be as far as 75 miles from a beneficiary. While state officials have expressed interest in ensuring closer access to specialists, in some parts of the state, 75 miles may be the closest they can get.
“You can't create providers,” Gary Jessee, the Medicaid director for Texas, said at the 6th Annual World Congress Medicaid Summit on Wednesday.
Another known challenge is the low Medicaid reimbursement rate, said Marcia Guida James, a senior director at Aetna Better Health. Aetna and other plans have compensated by offering incentive payments if providers meet certain quality metrics.
“We know Medicaid reimbursement is lower than commercial and other forms of payments,” James said at the summit. “What we can do is develop incentives. That improves reimbursement for providers and leads to better quality of care for members of the health plan.”
But even that strategy may not attract providers, said Jill Fyock, administrative director of managed care at ProMedica Health System, based in Toledo, Ohio. Doctors in her network have to track as many as 160 metrics across payers.
If a state or plan wants to introduce quality metrics, it should attempt to have them overlap with metrics already being tracked by providers, she said.