aamc.org does not support this web browser.
  • Washington Highlights

    CMS Finalizes Rule on Ensuring Access to Medicaid Services

    Shahid Zaman, Director, Hospital Payment Policy
    For Media Inquiries

    The Centers for Medicare & Medicaid Services (CMS) issued on April 22 the "Ensuring Access to Medicaid Services" final rule, containing provisions on ensuring access to care across Medicaid fee-for-service (FFS) and managed care, including for home and community-based services (HCBS). Of note, the rule would enforce payment adequacy provisions in Medicaid FFS by requiring states to:

    • Publish all FFS Medicaid fee schedule payment rates on a publicly available and accessible website.
    • Compare their FFS payment rates to Medicare rates for primary care, OB-GYN care, and outpatient mental health and substance use disorders services, and publish the results every two years. Hospital inpatient and outpatient services are omitted from these rate analyses. 
    • Perform an access analysis before proposed Medicaid rate reductions or rate restructuring that could result in reduced access.

    The CMS also finalized a requirement that states ensure that 80% of Medicaid payments for certain HCBS be made to direct care workers, instead of being allocated to overhead or profit. The CMS has published a list of the effective dates of various provisions of the rule, which vary by topic.