CMS is ready to roll out a new rule that repeals the current Medicaid access rule. While they offer important reasons for doing so, there are many opponents who say it will overall have a strong negative effect on care for patients.

What is the Medicaid access rule?

The current rule on the books for Medicaid Access requires states to oversee and audit all fee-for-service Medicaid payments to doctors, as well as their effect on overall care available to beneficiaries. The repeal of this rule by CMS, the Centers for Medicare and Medicaid Services, is meant to decrease what’s an immense burden on the states in terms of paperwork, having to document everything as well as prove pertinence to care. While this is mean to ease this load, and it most certainly will, doctors and patient advocates are worried about the impact this will have on patient care.

What they see happening is that there is now an opening for the states to reduce payments to doctors without having to show that there is a correlation between declining standards of care. So if they don’t pay out, and a patient doesn’t receive necessary treatments, CMS will never know.

Why there’s opposition

The American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics, the American Psychiatric Association, the American College of Obstetricians and Gynecologists, and the American Osteopathic Association put out a joint statement saying that “Multiple data sources show that payment is the primary driver in determining physician participation in the Medicaid program, and the proposed rule could lead to increasingly insufficient Medicaid payment rates, seriously jeopardizing patients’ ability to access health services.” With reduced payments, doctors may opt out and decrease the patient’s access to services.

Advocates worry about how this will adversely affect this particular population. They are already at risk  of less health care if they are on the Medicaid program, and this new rule will lessen the quality of their health care even more. As an insurance program, it’s meant to cover health services for this population, and this allows the states to cut out services that they need. This will have the most significant impact on hospitals that serve this population, often safety-net hospitals, and need the reimbursement to continue providing high quality care. Dr. Rod Hochman, president and CEO of Providence St. Joseph Health, said “The most vulnerable and at-risk population groups, such as the aged and disabled, remain in FFS (fee-for-service) Medicaid.”

The Medicaid rule also states explicitly that payments must be high enough 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.” A 2015 court ruling said that patients could not contest states compliance with this rule through the court system, so pressure from CMS is their only leverage.

So far, several states have praised the move, as it tremendously relieves their own burden. Doctors are hoping that the new rule won’t go through and that they will be able to continue to provide the quality care they can to Medicaid patient.

Patients can check with a local adviser to see how they can make Medicaid work for them in their stay at Hudson View.

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