CMS Releases Proposed Regulation Intended to Alleviate State Burden

March 2018 ~

CMS issued a notice of proposed rulemaking (NPRM) for a regulation aimed at providing state flexibility from certain regulatory access to care requirements within the Medicaid program.

According to CMS, the proposal seeks to amend the process for states to document whether Medicaid payments in fee-for-service (FFS) systems are sufficient to enlist providers to assure beneficiary access to covered care and reduce regulatory burdens at the state level.

Specifically, the rule would exempt state managed care programs from requirements to analyze certain data and monitor access if a state delivers 85% of its Medicaid coverage through managed care. CMS would assist states by providing beneficiary access guidelines for managed care programs.

If passed, the proposal would also provide similar flexibility to all states when they make nominal rate reductions to FFS payment rates. Medicaid FFS programs that reduce payments up to a maximum of 4%, as well as a maximum of 6% over two consecutive years, would also be exempt from beneficiary access analyses.

When states reduce Medicaid payment rates, they would rely on baseline information regarding access under current payment rates, rather than be required to predict the effects of rate reductions on access to car.

In the press release, CMS states the NPRM comes in response to state concerns regarding the administrative burdens associated with certain reporting requirements set by the “Medicaid Program: Methods for Assuring Access to Covered Medicaid Services” final rule (published in November 2015) which states claim are not a proactive use of state resources when Medicaid FFS enrollment is limited.

“States with few Medicaid members enrolled in their fee-for-service program or when members are only temporarily enrolled, and states making small reductions to fee-for-service payment rates, have urged CMS to consider whether analyzing data and monitoring access in that program is a beneficial use of state resources,” CMS said in the release.

The agency said the rule supports federal efforts to explore state Medicaid and estimates the proposed changes would reduce state administrative burden by 561 hours and reap a total savings of over $1.6 million.

“Today’s proposed rule builds on our commitment to strengthening the Medicaid program and assist those it serves through state partnerships that improve quality, enhance accessibility and achieve outcomes in the most cost effective manner,” said CMS Administrator Seema Verma. “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.”



Source(s): CMS Press Release; Healthcare Dive: Payer; HFMA;