CMS Proposes Easing Medicaid Access Protections

States would have to do less to ensure access to Medicaid-covered services for their Medicaid population under a new regulation proposed by the Centers for Medicare & Medicaid Services.

In 2015, CMS required states to track their Medicaid fee-for-service payments and submit them to the federal government as part of a process to ensure that Medicaid payments were sufficient to ensure access to care for eligible individuals.  Now, CMS proposes rescinding this requirement, writing in a news release that

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.

The proposed regulation itself explains that

While we believe the process described in the current regulatory text is a valuable tool for states to use to demonstrate the sufficiency of provider payment rates, we believe mandating states to collect the specific information as described excessively constrains state freedom to administer the program in the manner that is best for the state and Medicaid beneficiaries in the state.

CMS also notes that the current requirement applies only to Medicaid fee-for-service payments even though most Medicaid beneficiaries now receive care through managed care plans, the payments for which are not subject to the same process.

The agency adds that it intends to

…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.

Because they care for so many Medicaid patients, the adequacy of the rates states pay for Medicaid services is especially important to private safety-net hospitals.

Learn more about CMS’s proposal in its news release on the subject or see the proposed regulation itself.  Learn about the process CMS intends to employ to replace its current approach to monitoring access to Medicaid services in this CMS informational bulletin.


New MACPAC Study Evaluates Medicaid, Medicare Payments

Medicaid payments to hospitals are comparable to or even higher than Medicare payments.

Or at least they are once supplemental Medicaid payments are included.

So concludes a new study by the Medicaid and CHIP Payment and Access Commission, a non-partisan legislative branch agency that advises the states, Congress, and the administration on Medicaid and CHIP payment and access issues.

In what MACPAC bills as the “first-ever study to construct a state-level payment index to compare fee-for-service inpatient hospital payments across states and to benchmark Medicaid payments to other payers such as Medicare,” the study found that

  • Across states, base Medicaid payment for inpatient services varies considerably, ranging from 49 percent to 169 percent of the national average. This variation is similar to the variation across states previously reported for physician fees.
  • States are not consistently high or low payers across all inpatient services due to differences in their payment policies.
  • Payment amounts for the same service can also vary within a state.

The MACPAC analysis also concluded that

  • Overall, Medicaid payment is comparable or higher than Medicare.
  • Specifically, the average Medicaid payment for 18 selected conditions was 6 percent higher than Medicare, and the average Medicaid payment for all but two of the conditions was higher than Medicare.
  • The average Medicaid payment for these 18 services was higher than Medicare in 25 states and lower than Medicare in 22 states.

Learn more about what MACPAC found in its new report “Medicaid Hospital Payment: A Comparison across States and to Medicare,” which can be found here, on MACPAC’s web site.

Will High Court Help Pave the Way to Higher Medicaid Payments?

In a case that could have nation-wide implications for health care providers, the U.S. Supreme Court will hear an appeal of a lower court decision that ordered the state of Idaho to raise Medicaid payments to providers serving the developmentally disabled because the state’s payments were too low.

gavelWhile litigants in some states have used the courts in recent years to seek redress for what they believed were inadequate Medicaid payments, Supreme Court action on that matter could have national implications:  if the court supports the state of Idaho’s appeal of the order to raise fees it could limit the use of litigation in the future as a means of increasing payments and improving access to care for the Medicaid population.  If, on the other hand, the court rejects the Idaho appeal, it could potentially open the door to more such litigation, especially in states with Medicaid payments that do not even cover the cost of services providers deliver.

The outcome of this case will be of special interest to private safety-net hospitals.  These hospitals care for especially large numbers of Medicaid patients and many are located in states that pay hospitals poorly for Medicaid services.

To learn more about the Idaho case, similar litigation elsewhere, and the implications of the case about to go before the Supreme Court, see this Kaiser Health News report.