CMS Releases Proposed Rules Addressing Access in Medicaid and CHIP

On Thursday, April 27^th, the Centers for Medicare & Medicaid Services released two proposed regulations that address access to care broadly for Medicaid recipients. The proposed rule that primarily affects HCBS is “Ensuring Access to Medicaid Services” (CMS-2442-P) – informally referred to as the ‘access’ rule. The second rule addresses Medicaid and CHIP managed care delivery systems – “Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality” (CMS-2439-P) – and is informally referred to as the ‘managed care’ rule. Provisions of this rule will affect state MLTSS programs as well. Both proposed rules will be formally published in the Federal Register on May 3^rd, with comments on both due on July 3^rd. The proposed access rule – if enacted – would impose sweeping new requirements on virtually all aspects of States’ HCBS programs: payment, critical incident systems, timely access to HCBS services, and quality reporting. Once available, we’ll provide a summary and detailed analysis for members.

• Click here to view the unpublished access rule.

• Click here to view the unpublished managed care rule.

• Click here to view the CMS fact sheets on specific provisions of both rules.