HHS-Proposed Rule on Medicaid Provider Payments

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May 6, 2011 the U.S. Department of Health and Human Services released the proposed rule for Medicaid provider payments. Due to financial restraints and the recession, many states have cut Medicaid payments to health care providers. The proposed rule aims to provide guidance on how to assure access to Medicaid beneficiaries through a system of access reviews. The rule will:

  • Generally prevent states from cutting Medicaid payments to providers unless they can show that Medicaid recipients will have “sufficient access” to care after the cuts;
  • States must continually monitor Medicaid recipients’ access to care and develop plans to fix any problems they discover;
  • States must measure and document access to “each covered benefit” at least once every five years;
  • “Beneficiary access must be considered in setting and adjusting” Medicaid payments to doctors, dentists, psychologists, hospitals, clinics, pharmacies, nursing homes and suppliers of medical equipment;
  • Suggest that states survey Medicaid recipients to see how much difficulty they had in scheduling doctor’s appointments; and
  • States should compare Medicaid payment rates with the amounts paid by Medicare or commercial insurers, with providers’ costs or with their customary charges.

The new rule does not apply to beneficiaries in Medicaid managed care plans.