A new proposed rule from CMS could relax some regulations related to care access for Medicaid beneficiaries, leaving states much to their own devices when monitoring and mandating patient care access for different Medicaid plans.
Previously, state Medicaid programs were beholden to federal mandates for network adequacy in Medicaid programs.
Network adequacy refers to the breadth of an insurance network and has a significant impact on patient access to care. When a network is not broad enough, patients may struggle to find a provider who is within their network lest they become liable to high out-of-pocket costs.
These federal mandates resulted in considerable regulatory burden, CMS officials state.
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“From my first day at CMS, the agency has made it a priority to partner with States so they have the flexibility they need to implement their Medicaid programs in the best way possible for their beneficiaries,” CMS Administrator Seema Verma said in a statement. “Rather than micromanaging State programs through complex federal mandates, CMS is easing the administrative burden on States while focusing on holding them accountable for delivering high-quality, accessible care to beneficiaries.”
Specifically, the proposal aims to get rid of provisions included in a November 2015 rule put in place by the Obama Administration. The 2015 rule requires state Medicaid agencies to submit an access monitoring review plan (AMRP) and to update the plan at least every three years. States are subject to other provisions within the rule that the current CMS administration says are costly to states.
The proposal comes in response to concerns CMS says it has received from various state Medicaid agencies. Agencies have reportedly questioned whether AMRPs are an effective measure of network adequacy considering the changing the landscape of Medicaid payment models.
Date: July 11, 2019