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