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CMS Proposes to Reduce State Reporting Requirements for Medicaid FFS Payment Rate Changes

March 23, 2018

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PRESS CONTACTS
Tannaz Rasouli, Sr. Director, Public Policy & Strategic Outreach

The Centers for Medicare and Medicaid Services (CMS) March 22 released a proposed rule that would decrease reporting requirements for states that reduce Medicaid fee-for-service (FFS) payment rates.

According to the proposal, a state making nominal changes to its FFS payment rates would not be required to report all changes to CMS. Additionally, CMS is proposing to exempt states from requirements to analyze certain data and monitor access in states with high Medicaid managed care enrollment.

The proposal responds to states’ requests that CMS consider changing reporting requirements for states with low Medicaid FFS enrollment or when states make reductions in FFS payment rates. States also have asked CMS to consider whether analyzing data and monitoring access are a beneficial use of state resources.  In response to these requests, CMS is proposing the following changes:

  • States with an overall Medicaid managed care penetration rate of 85 percent or greater (currently 17 states) would be exempt from most access monitoring requirements
  • Reductions to provider payments of less than four percent in overall service category spending during a state fiscal year (and six percent over two consecutive years) would not be subject to the specific access analysis
  • 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 care, which states have found difficult to do.

The deadline for submission of public comments is May 22.

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