On Thursday, March 23, 2018, the Centers for Medicare and Medicaid Services (CMS) has released a new proposed rule entitled Methods for Assuring Access to Covered Medicaid Services- Exemptions for States with High Managed Care Penetration Rates and Rate Reduction Threshold.

In this rule, CMS proposes to exempt states with at least 85 percent of their Medicaid population in managed care from most access-monitoring requirements for services provided through the traditional fee-for-service avenue. The 85 percent threshold, which would be calculated to include services provided under comprehensive risk contracts between a state and a managed care organization, was chosen based on feedback from a November 2015 final rule with comment period. CMS states that this exemption would apply to 17 states and they are seeking comment on whether the 85 percent threshold is appropriate.

In addition, CMS is proposing to exempt provider pay cuts that amount to less than 4 percent annually or less than 6 percent over two years from certain access analyses. CMS is also requesting comments on these thresholds. Finally, CMS is proposing to remove the requirement that states submit ana analysis of the effect payment rate changes will have on access. Instead, CMS would require that states submit an assurance as well as baseline data in support of the state’s conclusions that current access is sufficient for those services impacted by rate changes.

CMS is aligning the proposals in this rule with President Trump’s commitment to “cut the red tape” and the agency goals to relieve unnecessary regulatory burdens. Additionally, in their press release, CMS states that this rule is part of a series of initiatives that are designed to help states focus more resources and time on patient outcomes. They are estimating that the changes in this proposed rule will reduce state administrative burden by 561 hours and save more than $1.5 million.

Comments on the proposed rule are due on May 22, 2018.