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  • Washington Highlights

    Final Medicaid Rule on Assuring Access to Covered Services

    Ivy Baer, Senior Director and Regulatory Counsel

    The Centers for Medicare and Medicaid Services (CMS) Nov. 2 published a final rule with comment period, Methods for Assuring Access to Covered Medicaid Services. On the same date, the agency also issued a Request for Information (RFI) – Data Metrics and Alternative Processes for Access to Care in the Medicaid program. Comments on both the final rule and the RFI are due Jan. 4, 2016.

    While states will be required to consider beneficiary access in setting and adjusting payment methodologies, the agency concludes that these issues can be addressed in ways other than increasing payment, such as redesigning service delivery strategies or improving provider enrollment and retention. The rule sets out a more consistent and transparent way for states to collect and analyze the necessary information to support review of State Plan Amendments. Through the RFI, CMS is gathering comments on which core access measures, thresholds, and appeals processes would provide additional information or approaches to ensure access to care for Medicaid beneficiaries.

    The rule and RFI were issued after the Supreme Court handed down a decision in Armstrong v. Exceptional Child Center, Inc. earlier this year that ruled neither providers nor beneficiaries have a private right of action to enforce state compliance with Medicaid, leaving enforcement in the hands of CMS.