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CMS Publishes a Final Rule Regarding each States Medicaid Programs

Posted on Wednesday, January 20, 2016 10:06 AM

CMS published a final rule called, “Medicaid Program: Methods for Assuring Access to Covered Medicaid Services CMS-2328-FC,” November 30, 2015. The rule explains that state Medicaid programs must follow procedures to ensure beneficiary access to care. States are undergoing several changes to this final rule. The following changes are outlined below:

  • Require states to review data
  • Evaluate access to care for covered services
  • Conduct public processes to obtain stakeholder input
  • Consider access in adjusting payment rate methodologies

In the final rule, CMS specifies that state Medicaid agencies must examine rate considerations in the following areas: provider charges, payment rates in Medicare, commercial insurance and Medicaid allowable costs. The final rule is just the beginning towards small improvements in state Medicaid.


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