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Stephanie Pellitt

, National Council for Behavioral Health

National Council Submits Comments on CMS Medicaid Access Rule

May 24, 2018 | Medicaid | Comments
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On Monday, the National Council submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding its proposed changes to the Medicaid access rule. The proposed changes would weaken the enforcement of federal requirements that ensure Medicaid enrollees have timely access to a variety of health care services. The National Council expressed strong opposition to these proposed changes as they would harm patients’ access to care for mental health and addiction services.


Delays in accessing needed treatments and services can lead to poorer health outcomes and unnecessary costs to the health care system. Recognizing this, the federal government created access monitoring requirements to ensure that the Medicaid program provides enrollees with timely access to high-quality, necessary care. With this rule, states demonstrate adequate access to care for Medicaid beneficiaries through important reporting and documentation requirements. The rule also provides federal oversight of key factors that influence treatment access, such a provider payment rates set by state Medicaid programs. Proposed changes to the access rule would weaken and even eliminate certain reporting and documentation requirements for states in their Medicaid Fee-for-Service (FFS) populations.


First and foremost, the National Council recommends that CMS not make any changes to the access rule at this time. Current data clearly shows that there is inadequate access to treatment for mental illness and addiction in FFS Medicaid and reducing the limited protections in the current access rule will exacerbate the problem. Furthermore, states have not yet had time to fully implement current access regulations to demonstrate their effectiveness.

However, should the Trump Administration choose to move forward with changes to the access rule, the National Council offers the following comments:

  1. Proposed Changes Would Hinder Access to Care for those Most in Need. CMS has proposed to exempt states from access monitoring requirements if more than 85% of the state’s Medicaid population is enrolled in managed care. This would immediately exempt at least 17 states from existing access monitoring requirements, and could exempt another dozen states whose Medicaid managed-care enrollment is growing close to the threshold. National Council recommends either removing this proposed change entirely or amending it to an absolute threshold of 5,000 or fewer beneficiaries not participating in managed-care.
  2. CMS Should Continue to Require Analysis of Proposed Rate Changes. The proposed rule would eliminate the requirement for an access impact analysis when states seek federal approval of changes to their FFS payment rates so long as the reduction was 4 percent or less or no greater than 6 percent over two years. However, access in many fee-for-service state Medicaid systems is already inadequate, largely due to inadequate provider payment rates. The National Council recommends that states should be required to analyze impact and access prior to cutting rates and that, at a minimum, any rate change of more than 2% over any number of years require an Access Monitoring Review Plan (AMRP) and approval by the Administrator of CMS.
  3. National Council Recommends the Use of Secret Shoppers to Understand True Access. Access should be measured by secret shopper surveys. Many behavioral health providers in Medicaid limit the portion of Medicaid patients in their caseload due to inadequate rates and decline to take on new patients. This renders the usual distance and provider per population analysis of access inaccurate and grossly over-estimated as compared to actual patient experiences. The revised rule should require the use of secret shopper surveys in preparing AMRP.
  4. National Council is Concerned about the Proposed Rule’s Impact on Laboratory Services. With the proposed rule, cuts in payment for laboratory services would not be subject to any meaningful monitoring of payment adequacy or impacts on access for Medicaid beneficiaries, causing downstream effects on consumers and state Medicaid budgets.

Overall, the proposed changes substantially weaken the effectiveness of current regulations and undermine the intent of the statute. Any revisions to current regulation should strengthen access, not weaken it. Read the National Council’s full comments here.