The CMS is teaming up with state Medicaid directors to set guidelines for managed Medicaid plans to ensure network adequacy.
In April, the CMS finalized a sweeping managed Medicaid rule 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 agency is aware that some states may struggle more than others in developing strategies that ensure adequacy, especially those with large rural populations. So, the CMS teamed up with Medicaid directors to create a guidance that will read more like a best-practices document, James Golden, director of the agency's division of managed-care plans, said at the Medicaid Health Plans of America conference on Thursday.
The document will likely be released in either January or February 2017, Golden said. The new contracts between states and plans go into effect on July 1, 2018.
Since the rule's release, stakeholders have said that it may not significantly improve access for Medicaid beneficiaries as it doesn't address the problem of recruiting and retaining providers to treat Medicaid patients.
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, who 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.