New rule may help CMS avoid high court rul­ing on state rates

Modern Healthcare - - Late News -

With a new rule, CMS of­fi­cials may be able to avoid hav­ing the U.S. Supreme Court set­tle the con­tro­versy over dis­parate state Med­i­caid pay­ment rates. The pro­posed rule would re­quire states to per­form an anal­y­sis of their pay­ment sys­tems un­der their feefor-ser­vice Med­i­caid pro­grams to de­ter­mine if their rates have cre­ated “ac­cess is­sues.” How­ever, even if such ac­cess prob­lems are dis­cov­ered, “states may be able to re­solve those is­sues through means other than in­creas­ing pay­ment rates,” the rule states. The pro­posed rule came af­ter the Supreme Court an­nounced this year that it would con­sider one of a grow­ing num­ber—and some­times con­flict­ing—fed­eral court rul­ings re­gard­ing the right of states to cut re­im­burse­ments for hos­pi­tals, physi­cians and other health­care providers as part of ef­forts to close the re­cent spate of bud­get deficits. The rule ex­plic­itly ac­knowl­edged that it is in re­sponse to those law­suits, stat­ing that court “de­ci­sions have left states with­out clear and con­sis­tent guide­lines and have sub­jected them to con­sid­er­able un­cer­tainty as they move for­ward in designing ser­vice de­liv­ery sys­tems and pay­ment method­olo­gies.” For the first time, states would be re­quired to “pe­ri­od­i­cally mon­i­tor” en­rollee needs, the avail­abil­ity of care and providers, and the uti­liza­tion of ser­vices to de­ter­mine if their Med­i­caid pro­grams pro­vide suf­fi­cient ac­cess to care.

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