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CMS Proposes Medicaid Rate-Setting Process

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CMS Proposes Medicaid Rate-Setting Process

May 6, 2011

CMS proposed an official rule in the Federal Register today that would require states to perform an analysis of their provider payment systems under their fee-for-service Medicaid programs to determine if their payment rates have created “access issues.” However, even if such access problems are discovered “states may be able to resolve those issues through means other than increasing payment rates,” according to the explanation of the proposed rule. For the first time, the rule would require states to “periodically monitor” enrollee needs, the “availability of care and providers,” and the utilization of services in their Medicaid programs to determine if it provides sufficient access to care. That information would be available for the public and the CMS to review. The proposed rule would allow states to resolve any provider access problems discovered through various steps, including “redesigning service delivery strategies, improving provider enrollment and retention efforts.”

The proposed rule came after the Supreme Court announced earlier this year that it would consider one of growing number—and sometimes conflicting—federal court rulings regarding the right of states to cut reimbursements for hospitals, physicians and other healthcare providers as part of efforts to close recent budget deficits. The proposed rule explicitly acknowledged that it is in response to those lawsuits.

The comment deadline is July 5th. ANCOR staff will be working within the Government Relations structure to offer comments. NOTE: The 2011 Annual Conference features a session that will walk attendees through the regulation and is an opportunity to contribute to ANCOR's comments to CMS.