Policy & Regulation News

CMS Final Rule Improves Medicaid Beneficiaries’ Care Access

“Through this rule, beneficiaries will have greater confidence in the services they receive from their Medicaid health care coverage.”

By Jacqueline DiChiara

- The Centers for Medicare & Medicaid Services (CMS) has released a final rule – effective on January 4, 2016 – that aims to advance the way covered services are measured and strengthen Medicaid beneficiary protection and care access.

Medicaid healthcare coverage beneficiaries

Says CMS in a recent press release, the final rule’s overarching objective is to provide an outline to help execute more educated, data-driven choices. Helping those who are most vulnerable when it comes to healthcare challenges is a key objective.

Such decisions will encourage efficient service delivery systems, service rate structures, and provider payment methodologies reflective of a Medicaid population that is both “unique and evolving,” CMS maintains.

The final rule, which is an extension of earlier 2011 proposed rule commentary, suggests yet another effort to boost the delivery of provided healthcare services, adds CMS.

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  • Meaningful access to services is imperative for the over 70 million individuals dependent upon Medicaid program for their healthcare coverage, CMS says. 

    “As our nation moves towards better sharing and utilizing of information to improve health access, treatment, and outcomes, it is critical for us to work together to ensure continued access to preventive, primary, and specialty service that are needed to maintain the health and well-being of our most vulnerable populations,” the organization adds.

    “Maintaining beneficiaries’ access to care is vital to the health of our nation and health of those who may not otherwise have access to essential health care services,” states Vikki Wachino, Deputy Administrator of CMS and Director with the Center for Medicaid and CHIP Services.

    “Through this rule, beneficiaries will have greater confidence in the services they receive from their Medicaid health care coverage,” Wachino adds.

    As RevCycleIntelligence.com reported, as states continue to squeeze provider reimbursements, there is perhaps an increasing commitment from leading healthcare movers and shakers to ensure Medicaid beneficiaries have suitable access to care.

    CMS’s final rule has 3 primary goals

    CMS maintains the following 3 goals regarding this final rule are indeed “fundamental” to the healthcare system:

    • measuring and linking beneficiaries’ needs and utilization of services with availability of care and providers;
    • increasing beneficiaries’ involvement through multiple feedback mechanisms; and
    • increasing 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.

    Additionally, CMS says the final rule enhances the organization’s ability to maintain consistency in Medicaid payment rates. Such consistency is primarily focused on efficiency, economy, quality, and care, in alignment with associated federal court decisions, CMS adds. 

    CMS seeks commentary until January

    CMS says it will accept commentary until January 4, 2016 regarding suggestions on how it can best ensure Medicaid access requirement compliance. At this time, states must meet the rule provisions' various mandates, CMS says. 

    Such includes commentary on the potential development of standardized core set measures of access, access to care thresholds, and how beneficiaries faced with various challenges can best access fundamental healthcare services.

    CMS says the process of accepting commentary will enable states to prepare an initial review plan analysis and verify whether or not provision adjustments are suitably sanctioned.