News Briefs: CMS Proposes New Medicaid Network Adequacy Regs

CMS on April 27 proposed new regulations that would “establish tangible, consistent access standards” in Medicaid as well as create “a consistent way to transparently review and assess Medicaid payment rates across states.” The new policies are included in two notices of proposed rulemaking — the Ensuring Access to Medicaid Services NPRM and the Managed Care Access, Finance, and Quality NPRM. Of note for the managed care industry, the proposed regulations would create national maximum standards for certain appointment wait times for Medicaid or Children’s Health Insurance Program (CHIP) managed care enrollees, CMS said. They would also create stronger state monitoring and reporting requirements related to access and network adequacy for Medicaid or CHIP managed care plans, and require states to conduct “independent secret shopper surveys” of Medicaid or CHIP managed care plans to verify compliance with appointment wait time standards and to identify where provider directories are inaccurate. Among other provisions, the NPRMs would additionally require states to conduct annual enrollee experience surveys for each Medicaid managed care plan, and establish a framework for states to implement a Medicaid or CHIP quality rating system, which CMS calls a “one-stop-shop” for enrollees to compare Medicaid or CHIP managed care plans based on quality of care, access to providers, covered benefits and drugs, cost, and other plan performance indicators.

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