White House Starts Review of Medicaid Payment Rule

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Sept. 14 — The White House Sept. 11 began reviewing a final rule on creating a process for states to follow when they set payment rates under Medicaid.

The final rule, from the Centers for Medicare & Medicaid Services (RIN 0938-AQ54, CMS-2328-FC), follows up on a proposed rule that was published in May 2011 by the CMS. The name of the rule is “Methods for Assuring Access to Covered Medicaid Services.” In April, a group of safety-net hospitals called on the CMS to release the long-awaited final rule and said the agency should ensure states pay higher Medicaid rates to protect beneficiaries' access to services.

In its April 28 letter to the federal Medicaid agency, America's Essential Hospitals said the final rule will ensure Medicaid beneficiaries have access to the same providers as the rest of the population. The group also said it wants providers to have “meaningful input” into review of state payment rate proposals.

The CMS released a proposed version (CMS 2328–P; RIN 0938–AQ54) of the rule in 2011 (76 Fed. Reg. 26,341, May 6, 2011).

There is no legal deadline for the final rule, according to a posting on the White House Office of Management and Budget's reginfo.gov website.

The OMB website also describes the rule as creating a standardized, transparent process for states to follow as part of their broader efforts to “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area,” as required by section 1902(a)(30)(A) of the Social Security Act (the Act). The rule is sometimes known as the 30(A) rule.

In April, the hospital group also noted that the CMS's role in ensuring that Medicaid pays adequate rates is especially important in the wake of a recent U.S. Supreme Court decision that prohibits Medicaid providers from suing state officials over insufficient payment levels. In Armstrong v. Exceptional Child Ctr., Inc., the court March 31 found Medicaid providers can't sue to force states to increase Medicaid payments for covered services.

The OMB said the rule also recognizes, “as States have requested, electronic publication as an optional means of communicating State plan amendments (SPAs) and proposed rate-setting policy changes to the public.”

Funding for IT 

The White House OMB also started reviewing on Sept. 11 another final rule, from CMS, this one on mechanized claims processing.

This final rule (RIN 0938-AS53, CMS-2392-F) revises Medicaid regulations for “Federal Funding for Medicaid Eligibility Determination and Enrollment Activities and Mechanized Claims Processing and Information Retrieval Systems,” the OMB said. The OMB added that the rule modifies regulations “so that the enhanced Federal Financial Participation (FFP) is available, under certain circumstances, for design, development and installation or enhancement of eligibility determination systems on an on-going basis.”

Enhanced FFP also will be available, under certain circumstances, for maintenance and operations of such systems, the OMB added. In addition to lifting the time limit that applies to the availability of such funding, the rule will make changes to the standards and conditions for Medicaid information technology “in order to access enhanced funding, and new approaches to systems development, acquisition approvals and formal certification,” the OMB website said.

A proposed rule was published in April (80 Fed. Reg. 20,455, April 16, 2015).


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