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CMS Final Rule Outlines Process to Ensure Meaningful Access to Medicaid Services

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Michael Petruzzelli

, National Council for Behavioral Health

CMS Final Rule Outlines Process to Ensure Meaningful Access to Medicaid Services

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The Centers for Medicare and Medicaid Services (CMS) issued a final rule this week aimed at strengthening Medicaid beneficiaries’ access to essential health care services. The rule establishes a framework for CMS to make better informed, data-driven decisions for both patients and providers. In particular, it focuses on the direct impact provider reimbursement has on patients’ ability to receive services. CMS is accepting comments on the rule until it goes into effect on January 4, 2016.

The primary goals of the final rule include:

  • Measure and link beneficiaries’ needs and utilization of services with availability of care and providers;
  • Increase beneficiaries’ involvement through multiple feedback mechanisms;
  • Increase stakeholder, provider, and beneficiary engagement when considering proposed changes to Medicaid fee-for-service payments rates that could potentially impact beneficiaries’ ability to obtain care.

In conjunction with the final rule, CMS also issued a Request for Information (RFI) soliciting feedback on additional approaches it and states should consider to ensure better compliance with Medicaid access requirements. CMS is looking to gather input on a number of provisions, including those related to the potential development of standardized core set measures of access, access measures for long-term care and home and community based services, and more. The deadline to participate in the RFI is also January 4, 2016.