FOR IMMEDIATE RELEASE
October 29,
2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
CMS strengthens
access to essential health care services for Medicaid beneficiaries
Meaningful access to health care services is
crucial for the 72 million Americans who rely on the Medicaid program for
coverage. As our nation moves towards better sharing and utilizing of information
to improve health access, treatment, and outcomes, it is critical for us to
work together to ensure continued access to preventive, primary, and specialty
service that are needed to maintain the health and well-being of our most
vulnerable populations.
The Centers for Medicare & Medicaid Services
(CMS) today released a final rule that not only improves our ability to measure
and ensure meaningful access to covered services, but also provides greater
safeguards for beneficiaries who may otherwise experience great difficulty in
receiving needed health care services. The intent of
this final rule is to provide a framework for us to use to make better
informed, data-driven decisions that support more effective service delivery
systems, service rate structures, and provider payment methodologies that
reflect our unique and evolving Medicaid population.
Building upon comments on the 2011 proposed rule, this final rule
signifies another step forward in strengthening the
delivery of health care services provided under the Medicaid program.
“Maintaining beneficiaries’ access to care is
vital to the health of our nation and health of those who may not otherwise
have access to essential health care services,” said Vikki Wachino, deputy
administrator of CMS, and director, Center for Medicaid and CHIP Services.
“Through this rule, beneficiaries will have greater confidence in the services
they receive from their Medicaid health care coverage.”
The goals of the final rule are fundamental to
our health care system: (1) measuring and linking beneficiaries’ needs and
utilization of services with availability of care and providers; (2) increasing
beneficiaries’ involvement through multiple feedback mechanisms; and (3)
increasing stakeholder, provider, and beneficiary engagement when considering
proposed changes to Medicaid fee-for-service payments rates that could
potentially impact beneficiaries’ ability to obtain care.
To support these three goals, the final rule
requires states to develop an access review plan that set out the data elements
and other information to be used to ensure beneficiary access to mandatory and
optional services; to establish new procedures to review the effects on
beneficiary access of proposed rate reductions and payment restructuring; and to
implement ongoing access monitoring reviews of key services, and additional
services as warranted. These provisions enhance meaningful access to health
care services by putting beneficiaries back at the center of their care.
The final rule also strengthens CMS’ ability to
review and ensure Medicaid payment rates are consistent with efficiency,
economy and quality and care. This aligns with the recent Supreme Court
Armstrong v. Exceptional Child Center, Inc., 135 S. Ct. 1378 (2015) decision,
which concluded that federal administrative agencies are better suited than
federal courts to make these determinations. The court ruling placed greater
importance on review and enforcement capability at the federal level; thus,
improving our ability to monitor, measure, and ensure access to care within
fee-for-service payment methodologies.
The final rule becomes effective on January 4,
2016, at which time states must meet the requirements established through the
provisions of the rule. During the 60-day period, CMS will accept comments from
the public on the access review requirements. This will enable states to begin
preparing their initial review plan analysis and to assess whether adjustments
to this provision are warranted.
In conjunction with the final rule, CMS today
released a request for information to solicit comments on additional approaches
the agency and states should consider to ensure better compliance with Medicaid
access requirements. This includes comments on the potential development of
standardized core set measures of access, access measures for long-term care
and home and community based services, national access to care thresholds, and
resolution processes that beneficiaries could use in facing challenges in accessing
essential health care services. CMS will accept response to the request for
information through January 4, 2016.
The final rule with comment and request for
information are available on the Federal Register at https://www.federalregister.gov/public-inspection starting October 29, 2015 and can be viewed at https://www.federalregister.gov starting November 2, 2015.
For more information, visit http://www.medicaid.gov/medicaid-chip-program-information/by-topics/access-to-care/access.html
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