CMS Releases Long-awaited Medicaid Equal Access Rule

Last week, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated Medicaid Equal Access Rule, which will help ensure that Medicaid recipients have equal and adequate access to services. INARF applauds the efforts of its national partner ANCOR in taking the lead on this issue in the wake of the recent US Supreme Court decision, Armstrong v. Exceptional Child Center, Inc. (Docket No. 14-15), which held that providers cannot sue states over inadequate reimbursement rates. Their leadership and advocacy both with the Administration and Congress were critical in securing the rule’s release. ​

In issuing the final rule with comments, CMS notes that in light of Armstrong the Medicaid equal access rule is needed to strengthen its’ framework for reviewing rates to ensure they are consistent with beneficiary access requirements and include strategies to improve access/care when shortcomings are identified. To that end, the rule provides guidance for states concerning how to ensure that Medicaid recipients have equal access to care as compared to individuals with private insurance. 

Specifically, the final rule requires states to develop an access review plan that sets out the data elements and other information to be used to ensure beneficiary access to mandatory and optional services; to establish new procedures to review the effects of proposed rate reductions and payment restructuring on beneficiary access; and to implement ongoing access monitoring reviews of key services, and additional services as warranted. 

The new Equal Access Rule goes into effect in January. In addition, CMS is seeking feedback concerning approaches the agency and states should consider to ensure better compliance with Medicaid access requirements. Feedback will be accepted until January 4, 2016. INARF plans to develop comments on this issue and will share broadly with members to encourage them to do the same. 

We hope you find this information helpful. Should you have questions or need any additional information, please contact your INARF office.