CMS Launches Comprehensive Effort to Strengthen Monitoring of Medicaid Beneficiary Access for Patients While Relieving Administrative Burden for States
Today the Centers for Medicare & Medicaid Services (CMS) issued a notice of proposed rulemaking to rescind outdated 2015 requirements that impose complex administrative burdens on States without meaningful impact to beneficiaries. This proposed rule is designed to help streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. CMS anticipates that the proposed rule would, if finalized, result in overall cost savings for State partners that could be redirected to better serve the needs of their beneficiaries. Concurrent with the proposed rule, CMS is also issuing guidance to States to remind them of their ongoing statutory responsibilities to ensure appropriate access to care for beneficiaries, while also outlining a strategy to develop a more comprehensive approach to monitoring access in Medicaid.
CMS’s goal is to ensure compliance with statutory requirements protecting access to care for Medicaid beneficiaries that will result in better care for patients, while eliminating unnecessary burden on States. To achieve this goal, if the proposed rule is finalized, CMS would replace the ongoing access reviews required by current regulations with a more comprehensive and outcomes-driven approach to monitoring access across delivery systems, developed through workgroups and technical expert panels that include key State and federal stakeholders.
“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,” said CMS Administrator Seema Verma. “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.”
Today’s proposed rule would rescind the administrative requirements of the 2015 final rule and would result in overall cost savings for States and allow States to focus on improving outcomes for beneficiaries. The November 2015 final rule issued by the previous Administration requires states to develop and submit an access monitoring review plan (AMRP) which has to be updated at least every three years to CMS for certain Medicaid services. The rule also imposes other complex administrative requirements when States propose certain changes to Medicaid provider payments.
Numerous states have raised concerns about both the administrative burdens and programmatic limitations of the AMRP, and questioned whether the process is the most effective or accurate reflection of access to care in a state’s Medicaid program. For example, the rule only applies to services delivered through fee-for-service programs, while the majority of Medicaid beneficiaries are now served through managed care.
Through this proposed rule and associated guidance, CMS continues its commitment to working with states to ensure sufficient access to care for their beneficiaries.
For more information regarding the proposed rule, please visit: https://www.federalregister.gov/documents/2019/07/15/2019-14943/medicaid-program-methods-for-assuring-access-to-covered-medicaid-services--rescission