- CMS created that rule in response to the Affordable Care Act’s optional Medicaid expansion. Increased payments allowed providers to meet more patient demand and improve patient access to care.
- AAFP also noted that Medicaid denial rates are extremely high, which also hinders providers’ ability to get paid for services rendered. Limited funding bars providers’ ability to offer primary care access.
The American Academy of Family Physicians has numerous issues with a March 2018 CMS proposal that changes the way states reimburse for Medicaid primary care services. Specifically, the medical group says the proposal could harm patient access to care.
In a May 21 letter to CMS Administrator Seema Verma, AAFP board chair John Meigs, Jr, MD, FAAFP, stated that the proposal would limit the amount Medicaid primary care providers get paid, making it difficult for providers to meet patient demand.
The CMS rule in question, “Medicaid Program; Methods for Assuring Access to Covered Medicaid Services—Exemptions for States With High Managed Care Penetration Rates and Rate Reduction Threshold,” was published in the Federal Register in March of this year. The rule proposes to change how states document payment rates for clinicians delivering primary care services.
The change would make it so states cannot document whether Medicaid payments are sufficient enough to enlist clinicians to deliver primary care services to patients. In many cases, this policy increased the amount of Medicaid funding states received, thus increasing the payments Medicaid providers received.
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This change could harm patient access to care, AAFP argued.
CMS created that rule in response to the Affordable Care Act’s optional Medicaid expansion. Increased payments allowed providers to meet more patient demand and improve patient access to care.
CMS said that these changes would restore individual state flexibilities regarding their Medicaid programs. However, AAFP contends that the proposed rule could do considerable damage to the Medicaid program.
“If CMS strives to ensure access to Medicaid covered services, the AAFP calls for urgent state and federal efforts to raise Medicaid physician payment levels to at least Medicare rates for services rendered by a primary care physician,” AAFP wrote.
“Lack of parity between these rates has historically created a demonstrable barrier to health care access for low-income, disabled, and elderly Medicaid enrollees, as many physicians are unable to afford new Medicaid patients due to low payment rates and significant administrative burden.”
AAFP pointed out research that confirmed the effectiveness of the prior CMS rule that Verma and the current Administration seeks to reverse.
A 2015 New England Journal of Medicine report showed that primary care access increased by 7.7 percent between 2012 and 2014 after CMS increased Medicaid payments. A separate article in JAMA Internal Medicine found that Medicaid care access increased between 2012 and 2014, while primary care access under private payer plans remained the same.
A 2018 JAMA Internal Medicine report found that reversing the Medicaid payment rule would decrease Medicaid primary care access because it would lower the means by which providers can deliver primary care to that population.
AAFP noted that there are already disparities emerging between Medicare and Medicaid payment rates. In some states, such as Rhode Island, Medicaid reimbursements are 33 percent of Medicare reimbursements. In Alaska, Medicaid payments are 127 percent of those in Medicare.
Nationally, Medicaid payment rates are 66 percent of those under Medicare.
AAFP also noted that Medicaid denial rates are extremely high, which also hinders providers’ ability to get paid for services rendered. Limited funding bars providers’ ability to offer primary care access.
The proposed rule also includes language that would exempt some providers from submitting an access monitoring review plan. States in which at least 85 percent of their population is enrolled in a managed care organization would be exempt from submitting an AMRP, but they would have to submit some care access data, CMS says.
This is a part of the Administration’s efforts to reduce administrative burden, according to Verma.
However, it is imperative that all Medicaid providers be held accountable for patient care access, AAFP asserted. This policy change is especially pressing for vulnerable patient populations and patients with numerous comorbidities or chronic illnesses. Limiting patient access to care for these populations could have dire health consequences.
“The AAFP opposes this proposal since it will almost certainly lower the level of access monitoring in those states,” AAFP concluded. “All Medicaid beneficiaries deserve access to high quality care as guaranteed by the Medicaid statute. Since this proposed rule impedes the federal government from confirming compliance with access to care for patients enrolled in Medicaid, the AAFP cannot support it.”
Date: May 25, 2018