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HHS/CMS | RIN: 0938-AU68 | Publication ID: Fall 2022 |
Title: Assuring Access to Medicaid Services (CMS-2442) | |
Abstract:
This rule proposes to address elements related to assuring access in Medicaid and/or the Children's Health Insurance Program (CHIP). These elements could include processes that support the implementation of a comprehensive access strategy as well as payment processes, such as those related to specific payment systems. |
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Agency: Department of Health and Human Services(HHS) | Priority: Other Significant |
RIN Status: Previously published in the Unified Agenda | Agenda Stage of Rulemaking: Proposed Rule Stage |
Major: Undetermined | Unfunded Mandates: Undetermined |
CFR Citation: 42 CFR 438 42 CFR 447 | |
Legal Authority: 42 U.S.C. 1302 |
Legal Deadline:
None |
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Statement of Need: In order to assure equitable access to health care for all Medicaid and CHIP beneficiaries across all delivery systems, access regulations need to be multi-factorial and focus beyond payment rates. Barriers to accessing health care services can be as heterogeneous as Medicaid and CHIP populations which can be measured through provider availability and provider accessibility to realized or perceived access barriers which can be measured through utilization and satisfaction with services. CMS is developing a comprehensive access strategy that will address not only Fee-For-Service (FFS) payment, but also access in managed care and Home and Community-Based Services (HCBS). |
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Summary of the Legal Basis: There are no broad access requirements specified in the statute beyond payment: section 1902(a)(30)(A) of the Act requires states to "assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area." |
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Alternatives: In developing the policies contained in this rule, we will consider numerous alternatives to the presented proposals, including maintaining existing requirements. These alternatives will be described in the rule. |
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Anticipated Costs and Benefits: This proposed rule would be expected to result in potential costs for states to come into and remain in compliance. Estimates for associated costs are unknown at this time and may vary by state. Information about anticipated costs will be included in the proposed rule. |
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Risks: Risks of the proposals in this rule are still under development and will be included in the published rule for comment. |
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Timetable:
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Regulatory Flexibility Analysis Required: No | Government Levels Affected: State |
Federalism: Undetermined | |
Included in the Regulatory Plan: Yes | |
RIN Data Printed in the FR: No | |
Agency Contact: Karen Llanos Director, Medicaid Innovation Accelerator Program and Strategy Support Department of Health and Human Services Centers for Medicare & Medicaid Services Center for Medicaid and CHIP Services, MS: S2-04-28, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-9071 Email: karen.llanos@cms.hhs.gov |