- CMS has issued a proposed rule relaxing certain administrative requirements in states with high Medicaid managed care populations.
- Under the proposal, states would not have to analyze and monitor access to care if an overwhelming share of covered lives received care through managed care plans.
- The rule would also make it easier for all states to make minor cuts to fee-for-service payment rates.
The proposal is part of the Trump administration’s drive to roll back regulations and reduce administrative red tape.
Currently, states must develop and submit an access monitoring review plan for Medicaid services provided via fee-for-service. The review plan must identify a data-driven means to review access to care, including availability of care through enrolled providers and changes in beneficiary service utilization. If states reduce Medicaid service rates, the affected services must be added to the review plan and the effects monitored for three years.
The proposed rule would change that by exempting states with an overall Medicaid managed care penetration rate of 85% or more from most access monitoring requirements. States meeting the threshold would attest to such at the start of each year. Currently, 17 states meet that criteria.
Further, provider payment cuts of less than 4% in overall service category spending for a given year, or 6% for two consecutive years, would be exempt from access analysis. And states making cuts to Medicaid payment rates would be able to use baseline information on access under current payment rates rather than having to predict how those rate reductions would impact access to care.
CMS said its goal is to do less micromanaging of state programs and focus instead on measurable program outcomes and holding states accountable for results.
The agency is accepting comments on the proposed changes through May 22.