Repealing Medicaid access rule could mean big cuts to provider payments
Skip to main content
Sister Publication Links
  • Modern Healthcare Metrics
MDHC_Logotype_white
Subscribe
  • Subscribe
  • Register
  • Login
  • News
    • This Week's News
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Nurses recycle surgical wraps for the homeless
      Nurses sew surgical wraps into sleeping bags for the homeless
      Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Wright Lassiter III
      Healthcare leaders urge full court press on social determinants of health
      $4.6 billion: Estimated annual costs of physician burnout, attributed to turnover and reduced clinical hours
      Data Points: Physician burnout rates vary by specialty
    • November was healthcare's second strongest hiring month of 2019
      Primary-care provider ChenMed to enter five new markets
      Lacking specialist access drives health disparities
      Genetic Counseling
      Addressing barriers to expanding genetic counseling
    • Joan Budden
      Q&A: Priority Health CEO eager to share best practices with Total Health Care
      Silver-loading, CSR elimination lowered premiums for some rural enrollees
      Centene to sell Illinois plan to CVS Health
      Blue Cross of Idaho unveils souped-up short-term health plans
    • Capitol Building with pills
      Week Ahead: House to vote on drug bill; SCOTUS hears risk-corridor case
      MedPAC thinks hospice payments are too high
      MedPAC says ambulatory surgical centers don't need a pay raise
      States focus on healthcare costs to address coverage problems
    • Analysts to CommonSpirit Health: Show us the savings
      Smallest hospitals saw biggest earnings gains last month
      Sutter Health postpones financial filing
      doctor helping patient stock image Sandoz
      Sponsored Content Provided By Sandoz
      As hospital executives look to reduce costs, biosimilars offer a compelling option
    • astronaut
      Astronauts developed bloodstream issues in space
      Sponsored Content Provided By ABM Healthcare
      Protecting and Maintaining Medical Devices
      human hand robotic hand stock image
      Sponsored Content Provided By Deloitte
      The Health System of the Future: How Digital Health Technology is Transforming Care
      EHR
      EHR vendors most in-use throughout Medicare incentive program
    • MRIs of dense breasts find more cancer but also false alarms
      Flu season takes off quickly in Deep South states
      Uber driver says South Carolina hospital dumped patient on him
      1 in 3 adults age 45 and older reported being lonely in a 2018 AARP survey
      Data Points: Loneliness and its impact on health
    • Jim Allison playing the harmonica
      Documentary tells tale of Nobel winning researcher
      Seema Verma
      Seema Verma's bold initiatives land her in No. 1 'Most Influential' spot
      New CEO takes the helm at Lurie Children's Hospital of Chicago
      Mayo Clinic taps Dr. John Halamka to lead its Google partnership
    • Midwest
    • Northeast
    • South
    • West
  • Special Features
    • Best Practices
    • InDepth Special Reports
    • Innovations
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Arkansas Children’s was a founding partner in Solutions for Patient Safety.
      Children's hospitals collaborate rather than compete on patient safety
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Linda Kenney
      Patient advocate recalls two medical errors that nearly killed her
      Man in hospital bed
      Minnesota looks to evolve its patient-safety reporting system
      Dr. Don Berwick
      Despite progress, we’re still waiting for a truly safer healthcare system
      Aurora Aguilar
      Culture of silence contributes to lack of progress on patient safety
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Paging Dr. Robot: Artificial intelligence moves into care
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • ProMedica doubles down on social needs data analysis
      Amazon taps first pharmacy for Alexa Rx management
      Trump administration unveils new price transparency rules
      A child being screened for vision problems using a smartphone.
      App screens kids for eye problems before they can talk
    • VA dives into artificial intelligence R&D
      Home health to pare down therapy services, up telehealth offerings
      Amazon launches medical transcription service
      Hospitals' uncompensated care continues to rise
    • Chest x-ray from a patient with a vaping-related lung injury
      Vaping-related cases lead to care guidelines from Intermountain
      Advanced ICU Care
      Telemedicine helps rural hospitals meet intensivist shortage
      Peer recovery specialists at St. Barnabas Medical Center work with nurse Brenna Zarra.
      Peer recovery helping patients with addiction seek treatment
      UNC Health Care trains staff to treat dementia patients
    • Value-based pay still struggles to improve costs, quality
      Hospitals sue HHS over negotiated price disclosure rule
      Bundled payments get a boost in two states with employee programs
      CMS wants primary-care docs to take on financial risk
  • Data/Lists
    • Rankings/Lists
    • Data Points
    • Modern Healthcare Metrics
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Randy Oostra, CEO of ProMedica
      HCR ManorCare deal laid foundation for ProMedica’s growth
      Steve Strongwater
      How Atrius Health stayed independent by not shying away from risk
      Why moving the VA to a new EHR was a pivotal decision
      Why AdventHealth's rebrand was more than a name change
    • Terry Shaw
      A diverse and inclusive culture should empower others
      Paving the path to diversity and inclusion
      The next step in healthcare evolution
      Breaking Bias: A road map to boost women and minorities into healthcare leadership
    • Dr. Richard Snyder
      Outdated privacy laws hinder coordinated care, especially in the fight against addiction
      David Dill and Keith Myers
      Healthcare partnerships are a proven path to better care, healthier communities
      Health systems need to devote more resources to caring for the caregivers
      Fawn Lopez and Bernard Tyson
      In remembrance and gratitude for a life well-lived
    • Letters: Let’s keep humanity in discussions about patient safety
      Hospital with money
      Letters: Let providers set their prices,
 and then publish them all
      Letters: Ambulatory surgery centers aren't getting a break on regulation
      Letters: Rising Medicaid spending isn't a windfall for providers
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Nominate
    • Award Programs
    • Previous Award Programs
    • Other Award Programs
    • Nominations Open - Top 25 Minority Leaders
      Nominations Open - Health Care Hall of Fame
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Top 25 Minority Leaders
    • Top 25 Women Leaders
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • Kronos webinar logo lockup
      Sponsored Content Provided By Kronos
      Webinar: The Future of Work in Healthcare
    • Leadership Symposium
    • Healthcare Transformation Summit
    • Critical Connections: Social Determinants of Health Symposium
    • Women Leaders in Healthcare Conference
    • Workplace of the Future Conference
    • Strategic Marketing Conference
    • Health Care Hall of Fame Gala
    • Top 25 Women Leaders Gala
    • Best Places to Work Awards Gala
    • Top 25 Minority Leaders Gala (2020)
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
 
Transformation Hub

Where healthcare challenges find solutions

  • Patients
  • Operations
  • Care Delivery
  • Payment
Payment
September 16, 2019 04:38 PM

Repealing Medicaid access rule could vastly lower provider pay, say opponents

Michael Brady
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    Provider and patient advocacy groups urged the CMS to rescind its proposed repeal of the Medicaid access rule, arguing that it would reduce access to care and create financial hardship for both beneficiaries and providers.

    The current Medicaid access rule requires states to monitor and document fee-for-service Medicaid payments and their impact on beneficiary access to care. The CMS is proposing to repeal that rule to ease the administrative burden for states with 85% or more of their beneficiaries enrolled in Medicaid managed care. The proposed rule would allow states to reduce reimbursement rates to fee-for-service providers without having to demonstrate to the CMS that the rate reductions won't reduce access to care.

    "CMS's proposal would put beneficiary access to care at greater risk," wrote the American Hospital Association in comments to the rule. "We believe that it is paramount that burden reduction efforts selectively target those burdens that are harmful, duplicative or provide no value. This proposed rule fails to meet this criteria."

    Providers and consumer advocates argue that waiving the rule will lead to significant cuts in state Medicaid reimbursements and decrease provider participation in the program, which will limit access and reduce the quality of care. The comment period closed Friday.

    "Multiple data sources show that payment is the primary driver in determining physician participation in the Medicaid program, and the proposed rule could lead to increasingly insufficient Medicaid payment rates, seriously jeopardizing patients' ability to access health services," said the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association and the American Psychiatric Association in a joint statement.

    Groups opposing the rule also claim the change will disproportionately affect certain providers like safety-net hospitals and community health centers, as well as specific patient populations such as the disabled and people who are eligible for both Medicare and Medicaid.

    "Medicaid is a health insurance program. Its purpose is to pay for medically necessary covered services for eligible individuals," wrote Georgetown University's Health Policy Institute officials. "Without providers who will serve them, Medicaid beneficiaries will not have access to the services they need."

    "Given our high volume of Medicaid business, we are concerned about any rule and regulations dealing with payment for care to people on Medicaid and their access to care," said officials with the Ohio State University's Wexner Medical Center.

    "The most vulnerable and at-risk population groups, such as the aged and disabled, remain in FFS Medicaid," wrote Dr. Rod Hochman, president and CEO of Providence St. Joseph Health.

    Medicaid's so-called "equal access provision" says that payments must be "sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area."

    Opposition groups say that Medicaid beneficiaries and providers have relied on the requirement to remedy complaints that state payments are insufficient to provide enough access to care. And because the Supreme Court ruled in 2015 that providers couldn't enforce the provision in federal court, the CMS is the only way for them to seek recourse. The CMS proposal would allow states with high numbers of managed-care participants in their Medicaid programs to submit a self-determined alternative analysis to the CMS. However, the agency hasn't outlined what the criteria for such an analysis might be.

    "The AAMC asks that CMS publish detailed standards by which the agency will review a state's alternative analysis," said the Association of American Medical Colleges. "If CMS finalizes the proposal, the agency should, at a minimum, revise the requirements to ensure states must continue to seek input from beneficiaries and providers."

    As states continue to face strong budgetary headwinds, they may see the removal of the CMS oversight as an opportunity to slash reimbursement payments. The proposed rule allows states to cut Medicaid payments by 4% during one fiscal year or up to 6% over two consecutive fiscal years with no reporting requirements.

    "In states where provider payment rates are already low, often due to a lack of rate increases over many years, a four to six percent rate reduction would have a significant impact," argued CalOptima, a public health plan in California.

    State Medicaid administrators, on the other hand, are generally supportive of the measure.

    "The implementation of the Access Rule Monitoring and Remediation Process has created an uncompensated administrative burden on Medicaid programs. The proposed changes would alleviate a significant amount of the burden for Medicaid programs," Idaho Medicaid officials wrote.

    But some state agencies would like to go even further. Arizona would like less oversight when it comes to cutting reimbursement rates for providers.

    "AHCCCS is concerned the proposed rules continue to require information be submitted by the State in support of nominal rate adjustments. This approach is inconsistent with the stated aims of the rulemaking and does not provide an exemption in practice that will diminish the administrative burden," wrote the Arizona Health Care Cost Containment System, which administers Medicaid in the state.

    Likewise, the state of Colorado asked that the CMS reduce the managed-care threshold in the proposed rule.

    Provider and consumer advocacy groups wonder if any changes are necessary because the administrative cost of the current rule is low. The CMS said in the proposed rule that, "This proposed rule is not economically significant with an overall estimated reduced reporting burden of $3,633,289," or about $71,000 per state.

    Tags: Payment, This Week in Healthcare, Centers for Medicare & Medicaid Services (CMS), Medicaid and CHIP Payment and Access Commission (MACPAC), Payment reform, Policy, Politics & Policy, Medicaid budgets by state data, Transformation Hub, Web Exclusives
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    Modern Healthcare
    Copyright © 1996-2019. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Special Features
      • Best Practices
      • InDepth Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Data Points
      • Modern Healthcare Metrics
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Nominate
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Top 25 Minority Leaders
        • Top 25 Women Leaders
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Leadership Symposium
        • Healthcare Transformation Summit
        • Critical Connections: Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
        • Workplace of the Future Conference
        • Strategic Marketing Conference
      • Galas
        • Health Care Hall of Fame Gala
        • Top 25 Women Leaders Gala
        • Best Places to Work Awards Gala
        • Top 25 Minority Leaders Gala (2020)
      • Webinars
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing