CMS Issues Draft Regulations Linking Medicaid Payment Policies and Access

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On Friday, April 29, 2011, the Centers for Medicare & Medicaid Services (CMS) issued draft regulations establishing a framework for states to apply in analyzing whether their Medicaid payment policies comply with federal access requirements. The proposed rules represent the first guidance from CMS with respect to how states should assess whether their payment policies provide sufficient access to care for beneficiaries under Section 1902(a)(30)(A) of the Social Security Act (Section (30)(A)).

While federal law gives states considerable flexibility in establishing payment methods and levels, it does require states to ensure that their payment policies (1) safeguard against unnecessary utilization of care, (2) ensure that payments "are consistent with efficiency, economy, and quality of care," and (3) are sufficient to ensure that Medicaid beneficiaries have the same access to healthcare services as the general population. The proposed regulations focus on the third requirement, often referred to as the "equal access" provision.

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