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FAH Statement | Medicaid | FAH Policy Blog Team

FAH Outlines Issues with Proposed Medicaid Access Rule

In a letter sent today to CMS Administrator Seem Verma, the FAH outlines several concerns with policies contained in the Medicaid Access Proposed Rule.  Under current Medicaid law, states are required to assure that Medicaid payments are “consistent with efficiency, economy, and quality of care are sufficient to enlist enough providers so that care and services are available…..”  In November 2015, CMS finalized regulations requiring states to use a process to document compliance with the legal standard for demonstrating sufficient payment.  The Proposed Rule issued by CMS and which the FAH commented on today, would inappropriately loosen those requirements.  

Areas highlighted in the letter include:

Disproportionate Impact on Vulnerable Beneficiaries

As many as 18 states would be exempt from current access monitoring requirements because at least 85% of their Medicaid enrollees are enrolled in comprehensive Medicaid managed care plans.

The letter states, “In FAH's view, current regulations are the minimum requirements in assuring states carefully consider the impact of states' policies on access. They require data, comparisons across different types of insurers and geographic areas, ongoing monitoring of rate changes and public feedback. Those activities continue to be critical for enrollees who receive their care through fee for service (FFS). We urge CMS to not finalize the exemptions for states with high managed care enrollment.”

“Nominal” Rate Reductions

Under the Proposed Rule, states implementing rate reductions below 4% in one year and 6% over two years would be exempt from access monitoring requirements and they would not need to seek public input on those rate reductions. In the Proposed Rule's preamble, CMS calls these “nominal” changes.

“If finalized, this threshold would allow a state to implement a 12% rate reduction over a period of 4 years or a 16% rate reduction over a period of 5 years without requirements for ongoing monitoring of the impact of the rate changes on access services. We believe that the imposition of rate reductions of those magnitudes is far from 'nominal' and the results of such reductions could be devastating for ensuring beneficiaries in the FFS delivery system have access to Medicaid services.”

Loss of Information

Under the Proposed Rule, states meeting the high managed care enrollment thresholds would no longer have to provide to CMS certain types of information, data or assumptions regarding its evaluation of access, including comparisons of rates among payers, analyses of access within geographic areas, and projections of the impact of rate reductions on access.

“The new rules would represent a major loss of information that may otherwise be used by CMS for overseeing the Medicaid program and assuring the programs are operated consistent with statutory requirements to assure access.”

You can find the complete letter here.