CMS issues rule, information request for monitoring access to care in Medicaid

The Centers for Medicare & Medicaid Services today issued a final rule requiring states to submit plans to monitor access to care for Medicaid beneficiaries, and establishing new review procedures for proposed rate changes in the Medicaid fee-for-service program. According to a CMS factsheet, the Access Monitoring Review Plans must provide for state reviews of five “core services”: primary care, physician specialists, behavioral health, pre- and post-natal obstetrics (including labor and delivery), and home health services. States may add additional services at their discretion; must monitor access for any service for which payments have been reduced or restructured; and must add services to the plan if they or CMS receive a high number of related access complaints, the agency said. “AHA is disappointed that CMS chose to exclude hospital services, except for labor and delivery hospital services, from this critical review process,” said AHA Executive Vice President Tom Nickels. “Failing to include such services means states will be able to continue to ignore patient needs and cut funds for hospital services with little federal oversight.” The rule will be published in the Nov. 2 Federal Register with a 60-day comment period. CMS also issued a separate request for information on additional approaches to ensure compliance with Medicaid access requirements. The final rule follows on a March Supreme Court ruling, which held that providers cannot challenge directly in federal court a state’s compliance with Section 30(a) of the Medicaid Act. The AHA and Federation of American Hospitals had urged the court to uphold the right of health care providers to take states to court when they fail to live up to their payment obligations under the Medicaid Act.