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March 27, 2018

At least 17 states could be exempt from Medicaid's network adequacy rule

Daily Briefing

    CMS on Thursday issued a proposed rule that would exempt some states from requirements to assess whether fee-for-service Medicaid beneficiaries can easily access certain health care services.

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    CMS in 2015 finalized a rule that standardized the process for states to document whether their provider networks meet access to care requirements for various health care services, including behavioral care, primary care, pre- and post-natal obstetric services, and specialty care.

    Proposed rule details

    On Thursday, CMS proposed exempting states from the access to care reporting requirements if at least 85% of their Medicaid populations are enrolled in managed care plans. CMS estimated 17 states—including Arizona, Florida, Kansas, and Kentucky—would qualify for the exemption if the proposed rule is finalized, Modern Healthcare reports.  

    CMS also proposed a change that would make additional states eligible for the exemption. The agency said states that lower Medicaid fee-for-service payment rates by less than 4% during a fiscal year, and by less than 6% over two consecutive years, would be eligible for the exemption. Under the proposed rule, those states would rely on baseline access to care information under current payment rates, instead of having to estimate the effects the rate reductions would have on access to care. CMS in the proposed rule said the agency "generally believe[s] changes below the 4% threshold to be nominal and unlikely to diminish access to care."

    CMS estimates the proposed rule would reduce the administrative burden on states by 561 hours and result in total savings of $1.6 million.

    CMS Administrator Seema Verma in a release said, "These new policies do not mean that we aren't interested in beneficiary access but are intended to relieve unnecessary regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries."

    CMS is accepting public comments on the proposed rule until May 23 (Morse, Healthcare Finance News, 3/22; Dickson, Modern Healthcare, 3/22; AHA News, 3/22; CMS release, 3/22).

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