0938-AU68 202210 The Regulatory Plan and the Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Assuring Access to Medicaid Services (CMS-2442)

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.

]]> Other Significant Previously Published in The Unified Agenda Proposed Rule Stage Undetermined Undetermined 42 CFR 438 42 CFR 447 42 U.S.C. 1302 Yes

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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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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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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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 of the proposals in this rule are still under development and will be included in the published rule for comment.

]]> NPRM 04/00/2023 No State Undetermined No No No Karen Llanos Director, Medicaid Innovation Accelerator Program and Strategy Support 0938 Centers for Medicare & Medicaid Services CMS 410 786-9071 karen.llanos@cms.hhs.gov Center for Medicaid and CHIP Services, MS: S2-04-28, 7500 Security Boulevard, Baltimore MD 21244