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CMS proposes new approach to monitoring protections for Medicaid beneficiaries

Current rule applies only to fee-for-service and most Medicaid beneficiaries are now served through managed care, stakeholders tell CMS.

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services has proposed rescinding a rule issued under the Obama Administration requiring states to develop and submit an access monitoring review program every three years.

The review program is to ensure that Medicaid beneficiaries have access to care.

But state officials indicated to CMS that the rule was outdated, as it only applies to services delivered through fee-for-service programs, while the majority of Medicaid beneficiaries are now served through managed care.

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Instead, CMS plans to replace the ongoing reviews with a more comprehensive and outcomes-driven approach to monitor beneficiary access across delivery systems. This would be developed through workgroups and technical expert panels of state and federal stakeholders.

CMS is also issuing guidance to states to develop a strategy for a more comprehensive approach.


The proposed rule is designed to streamline federal oversight of access to care requirements that protect Medicaid beneficiaries. 

The current rule puts an administrative burden on states without having a meaningful return for beneficiaries, CMS said. Getting rid of the rule should result in an overall cost savings to states.


CMS said it wants to reduce administrative burden that shows no clear benefit.

The 2015 final rule requires states to update the access monitoring review plan every three years. The rule also imposes complex administrative requirements when states propose certain changes to Medicaid provider payments.


"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."

Twitter: @SusanJMorse
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