ASHA Comments on CMS Proposed Rule to Expand Access to Care for Medicaid Beneficiaries

ASHA has submitted comments [PDF] responding to the Centers for Medicare & Medicaid Services (CMS) notice of proposed rulemaking on expanding access to care for Medicaid beneficiaries enrolled in Medicaid managed care plans (“Managed Care Rule”).

Benefiting Patients and Providers Alike

The purpose of the Managed Care Rule is to increase Medicaid beneficiary access to services provided through Medicaid Managed Care organizations (MCOs). Most Medicaid services are delivered through managed care and 41 states use capitated models—where health plans receive a defined amount of money to cover the health care services incurred by one patient over a set amount of time—to deliver services. In the proposed rule, CMS acknowledged that some of the most common feedback received in response to their Request for Information (RFI) last spring focused on using provider reimbursement rates as a driver to increase provider participation in the Medicaid program.

ASHA’s comments to the Managed Care Rule focused on several proposed requirements, including enrollee experience surveys, appointment wait time standards, secret shopper surveys, and proposals to require MCOs to calculate and publish provider payment analyses comparing Medicaid rates to those of the Medicare fee schedule.

ASHA provided many recommendations, including that CMS require MCOs to:

• Survey Medicaid providers annually just as they survey Medicaid beneficiaries;
• Reimburse providers at rates no less than those of the Medicare fee schedule, to the extent legally permissible;
• Create robust provider networks so that appointment wait time standards will be truly achievable for currently enrolled providers;
• Establish wait time standards for all providers, but especially specialty providers like audiologists and speech-language pathologists; and
• Conduct secret shopper surveys anonymously on provider availability to promote true validity of the data gathered.

What’s Next

ASHA’s hopeful these regulations will be finalized in fall 2023, though it’s our understanding that CMS would like them finalized before the next President is elected in 2024. We will notify members of what is included in the final rule as soon as it’s published.

Background

These proposed rules were drafted to achieve President Biden’s Executive Orders 14009 [PDF] and 14070 [PDF] for helping states strengthen their Medicaid programs and improve quality and access to care. The substance of the rules comes directly from feedback gathered through CMS’s spring 2022 RFI, which ASHA submitted robust comments [PDF]. ASHA also contributed to comments from the Consortium for Constituents with Disabilities, which ASHA is a member and co-chair on its Health Task Force, for both the Managed Care Rule [PDF] and the Access Rule [PDF].

Questions?

For questions, please contact ASHA’s health care and education policy team at reimbursement@asha.org.