FHA Comments: Medicaid Access
January 4, 2016
Page 1
Submitted electronically
January 4, 2016
Andrew M. Slavitt, Acting Administrator
Centers for Medicare & Medicaid Services
Hubert H. Humphrey Building
200 Independence Avenue, S.W., Room 445-G
Washington, DC 20201
RE: Final Rule with Comment Period: CMS-2328-FC/RIN 0938-AQ54 Medicaid Program: Methods for Assuring Access to Covered Medicaid Services (Vol. 80, No. 211, November 2, 2015)
Dear Mr. Slavitt:
On behalf of our over 200 member hospitals and health systems, the Florida Hospital Association (FHA) appreciates the opportunity to comment on the Centers for Medicare & Medicaid Services’ (CMS) final rule with comment on methods for assuring access to covered Medicaid services. The final rule requires states to submit plans to monitor access to care for Medicaid beneficiaries and establish new review procedures for proposed rate changes in the Medicaid fee-for-service program. It also establishes procedures that states must follow to ensure that beneficiary access to core services is not affected before CMS approves a state’s plan to cut or restrict provider rates.
The following are the core services that must be reviewed by the state at least every three years – primary care services, physician specialist services, behavioral health services, pre- and post-natal obstetric services including labor and delivery, and home health services. The state must also look at any additional types of services where rates have been reduced or restructured or for which the state or CMS has received a higher-than-usual volume of complaints related to patient access. Unfortunately, states are given flexibility in determining what constitutes a high number of complaints.
The FHA is extremely disappointed that CMS chose to exclude all hospital services, except for labor and delivery, as a core service in this critical review process. Failing to include such services means states will be able to ignore patient needs and cut funds for hospital services with little federal oversight. Such oversight is needed to help ensure access to the full spectrum of care for the vulnerable Medicaid population. This final rule is particularly important in light of a March Supreme Court decision in Armstrong v. Exceptional Child Center Inc., which found that Medicaid providers cannot contest state-determined Medicaid payment rates in federal court. The newly required access plan is the only way to hold states and CMS accountable when considering provider payment rate changes.
The FHA recommendsthat CMS expandthe listofcore servicesrequired for state accessmonitoringreviewplanstoinclude hospitalservices by revising and reissuing the final rule or by withdrawing the rule issued on November 2, 2015, and issuing a proposed rule open for comment. IfCMS intends to meaningfully hold states accountable formeetingthe statutoryrequirements that provider payments shouldbe sufficient to ensurebeneficiaries access to care, the FHA
believes that all inpatient hospital services must be included, not just labor and delivery. It is obvious that inclusion of all inpatient hospital services in the core set of services included in the access plan fits the rule’s characterization of core services, defined as those “…both in high demand and commonly utilized by Medicaid beneficiaries.” Failure to do so would mean that CMS is failingto create meaningfuloversight of state provider payments to ensure sufficient access to servicesfor thevulnerable populations served bythe Medicaid program.
Thankyou foryourconsideration of ourcomments.Ifyou have anyquestions, pleasecontact me at or at (407) 841-6230.
Sincerely,
Kathy Reep
Vice President/Financial Services