New Medicaid rule falls short of ensuring access to care, providers say

January 5, 2016



Physicians and hospitals want the CMS to require state Medicaid agencies to do more to make sure beneficiaries have access to care than called for under regulations issued last fall. A final rule published this past October outlines how Medicaid agencies must monitor access, particularly when they cut payment rates for physicians.

A draft version of the regulations was published in May 2011 as several states sought to reduce payments to providers in response to budget shortfalls fueled by the Recession.


The U.S. Supreme Court, in the meantime, ruled in March last year that beneficiaries and providers can't sue state Medicaid agencies over rate cuts. The CMS notes in the final rule that the decision puts even greater onus on the agency to make sure the programs pay providers enough to ensure access to high quality care. The regulations require state Medicaid agencies to measure beneficiaries' health needs and the availability and use of services. They must conduct the assessment every three years and within a year of cutting rates to providers.



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