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This rule proposes to assure and monitor equitable access in Medicaid and the Children’s Health Insurance Program (CHIP). These activities could include actions that support the implementation of a comprehensive access strategy as well as payment specific requirements related to particular delivery systems.

Statement of Need:

In order to assure equitable access to health care for all Medicaid and Children’s Health Insurance Program (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 ranging from potential barriers to access 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. CMCS 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). The scope of this rule is unknown at this time, but will seek to assure and monitor equitable access in Medicaid and CHIP.

Summary of the Legal Basis:

At this time, the scope of the rule is unknown. However, 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."

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.

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.

Risks:

At this time, we are still at work developing a comprehensive access strategy.  We have not yet concluded which pieces are best done through rulemaking versus other guidance.