Do Medicaid Rates Attract Enough Providers? New rules help states figure out if there are enough providers to meet beneficiaries’ needs—and if reimbursement rates affect that access to care. News in Brief
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News in Brief  |   February 01, 2016
Do Medicaid Rates Attract Enough Providers?
Author Notes
  • Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plan and Medicaid advocacy. lalbanhavens@asha.org
    Laurie Alban Havens, MA, CCC-SLP, is ASHA director of private health plan and Medicaid advocacy. lalbanhavens@asha.org×
Article Information
Practice Management / News in Brief
News in Brief   |   February 01, 2016
Do Medicaid Rates Attract Enough Providers?
The ASHA Leader, February 2016, Vol. 21, 12. doi:10.1044/leader.NIB1.21022016.12
The ASHA Leader, February 2016, Vol. 21, 12. doi:10.1044/leader.NIB1.21022016.12
ASHA members and state speech-language-hearing associations may be able to help ensure that Medicaid beneficiaries in their states have access to speech-language and hearing services under rules that took effect Jan. 1, 2016.
The final Medicaid rule, issued by the Centers for Medicare and Medicaid Services (CMS) last fall, requires states to submit plans that outline how they will ensure access to covered health care services and to look at how any cuts to provider payments will affect that care.
The federal guidance gives each state latitude to determine how it will measure access to care for its beneficiaries, but recommends that providers be included in decision-making. Through this recommendation, ASHA members and state associations have an opportunity to work with state Medicaid directors, health departments and other offices to influence the decisions made in their states.
The rule also asked for comments from stakeholders about what services should be included in reviewing access to care. ASHA recommended that Early, Periodic, Screening, Diagnosis and Treatment (EPSDT) services be subject to review, as this selection would ensure inclusion of audiology and speech-language pathology services for children as mandatory benefits.
ASHA also conveyed its concern about a limitation of the final rule—that it applies only to fee-for-service Medicaid plans and not to Medicaid managed care plans. ASHA continues to advocate with CMS on the variety of ways managed care plans interpret EPSDT requirements.
The final rule comes more than four years after the proposed rule was issued. ASHA submitted comments in support of the rule, but also requested that CMS provide additional explanation in five key areas: delivery systems (telepractice, for example), managed care organizations, pricing, payment methods and timely notification of changes.
The comments addressed the need for CMS to create a standardized, transparent process that ensures Medicaid payments would be consistent with efficiency, economy and quality of care, and that enlist an adequate number of providers to meet the needs of the Medicaid-eligible population in each area.
The rule addresses these areas, but does not outline specific standards.
In issuing the rule, CMS requested feedback on approaches that the federal government and states should consider for access to care information: data collection and methodology, thresholds/goals, alternative processes (appeals), and measures. ASHA suggests that:
  • Metrics be person-centered, reflect qualified providers, recognize the various treatment settings and include services covered under EPSDT.

  • Thresholds be considered as minimal requirements to ensure access.

  • Appeal procedures be developed for beneficiaries and providers, including an exceptions process to ensure coverage for people with unique and/or multiple medical conditions.

  • CMS use the Medicare patient satisfaction and provider surveys as a starting point for metrics, with adjustments made specific to the Medicaid population. For beneficiaries, these surveys address ease of finding a provider and scheduling appointments and satisfaction with care. Provider questions should include processes for referrals and provider enrollment.

In issuing its request for information, and in the latitude it gives to individual Medicaid plans, CMS is still open to input on how to ensure access and what aspects of state plans should be subject to review. ASHA recommends that audiologists and speech-language pathologists offer input from the provider perspective to the decision-makers in their states. Contact information for state Medicaid directors is available online.
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February 2016
Volume 21, Issue 2