The Centers for Medicare and Medicaid Services has issued a proposed rule that would give states that have a vast majority of their Medicaid beneficiaries in managed care, an exemption from certain regulatory requirements for assuring access to covered services.
The proposed changes are estimated to reduce the state administrative burden by 561 hours with a total savings of over $1.6 million.
Those states that have 85 percent or greater of their Medicaid populations in managed care would be exempt from most access monitoring requirements.
CMS regulations already separately provide for access requirements in managed care programs.
Seventeen states currently would qualify.
More states could qualify if they make nominal rate reductions to fee-for-service payment rates, CMS said.
Specifically, reductions to provider payments of less than 4 percent in overall service category spending during a state's fiscal year, and 6 percent over two consecutive years, would not be subject to the access analysis.
States that reduce Medicaid payment rates could then rely on baseline information on access under current payment rates, rather than be required to predict the effects of rate reductions on access to care, which state officials have told CMS they found very difficult to do.
CMS had issued a final rule on Medicaid in November 2015 covering methods for assuring access to covered Medicaid services.
States with few Medicaid members enrolled in their fee-for-service program or who were only temporarily enrolled, and states making small reductions to fee-for-service payment rates, urged CMS to consider whether analyzing data and monitoring access was a beneficial use of state resources.
This proposed rule furthers President Donald Trump's commitment to "cut the red tape," said CMS, and is part of a series of initiatives aimed at helping states focus more resources and time on patient outcomes in their Medicaid programs.
These proposed regulatory changes do not change the underlying statutory responsibilities for states to ensure that Medicaid recipients have appropriate access to services. However, they are designed to support CMS efforts to move away from micromanaging state programs and instead focus on measuring program outcomes and holding states accountable for achieving results.
"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," said CMS Administrator Seema Verma. "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."
Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com