CMS would exempt 17 Medicaid managed care states from most access monitoring

In a proposed rule, CMS would loosen requirements for states with Medicaid managed care programs on analyzing and monitoring access to care, a move the agency said would provide additional relief on “burdensome” regulations finalized by the prior administration.

In this case, the regulation CMS seeks to change is a Nov. 2015 rule on how Medicaid managed care program measure access to covered services in the program. Under that rule, when states are changing Medicaid payment rates, they have to analyze data and any supporting information on sufficient access for services under fee-for-service Medicaid like primary care and behavoral health by submitting an Access Monitoring Review Plan (AMRP). This may not be the best use of state resources, CMS said, in states with few permanent FFS Medicaid members or where payment reductions have been small.

Under the proposed rule, in the 17 states where 85 percent of their Medicaid populations are covered by managed care programs, they would be exempt from most access requirements. Additionally, payment reductions of “less than 4 percent in overall service category” during a state’s fiscal year, and 6 percent over two consecutive years, wouldn’t be subject to “specific access analysis.”

“Today’s proposed rule builds on our commitment to strengthening the Medicaid program and assist those it serves through state partnerships that improve quality, enhance accessibility and achieve outcomes in the most cost effective manner,” CMS Administrator Seema Verma, MPH, said in a statement. “These new policies do not mean that we aren’t interested in beneficiary access, but are intended to relieve unnecessary regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.”

Additionally, when states reduce payments under Medicaid, the rule would have them “rely on baseline information regarding access under current payment rates,” instead of attempting to predict how rate reductions will impact access.

CMS cautioned states this wouldn’t change existing laws on ensuring Medicaid beneficiaries have appropriate access to healthcare. The motivation was to stop “micromanaging state programs” by alleviating regulatory burdens. CMS estimated these proposed changes would save states a total of $1.6 million annually.