CMS Requires That Beneficiary Access Be Considered When Setting Payment Methodologies

State Medicaid programs must consider beneficiary access to services in their rate setting and adjustment payment methodologies, according to a final rule issued on November 2, 2015, by the federal Centers for Medicare & Medicaid Services (CMS). The final rule provides for a transparent process based on access data in which states will document whether Medicaid payments are sufficient to recruit provider organizations.

In the final rule, "Medicaid Program; Methods for Assuring Access to Covered Medicaid Services" CMS noted that comments will be accepted through January 4, 2016. The final rule requires states to do the following:

Develop an access . . .