CMS Proposes New State Process to Ensure Access to Medicaid Services

On May 6, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule in the Federal Register that would require states to implement a new standardized review process to ensure compliance with statutory Medicaid access requirements. The proposal relies on the framework recently developed by the Medicaid and CHIP Payment and Access Commission (MACPAC), which focuses on three categories: enrollee needs, the availability of care and providers, and service utilization. States would have flexibility to determine the appropriate measures to demonstrate and monitor access to care within each category. In addition, the proposal would only apply to Medicaid services paid through a state plan under fee-for-service, not services provided through managed care arrangements. It also would not apply to the Children’s Health Insurance Program (CHIP). HHS is seeking feedback on the proposal, with comments due by July 5, 2011.