In this letter to HHS Secretary Alex Azar, MACPAC comments on a March 2018 rule proposed by the Centers for Medicare & Medicaid Services (CMS), which would amend the process states must use to document whether payments in fee-for-service (FFS) Medicaid are sufficient to meet Medicaid requirements for equal access to services under the Social Security Act.
MACPAC expressed concern about the rule’s proposal to exempt states with high managed care enrollment from monitoring access in FFS, among other changes. The Commission observed that even though managed care is now the dominant delivery system in Medicaid, more than half of national Medicaid spending continues to be through FFS. The Commission also noted that even in states with high managed care penetration, some services—such as long-term services and supports, dental services, and behavioral health services—continue to be provided through FFS. The Commission also expressed concerns about the proposal to exempt certain payment rate changes from reporting requirements.
Although Commission acknowledged that limited state resources are a legitimate concern, it suggested that Medicaid access requirements should be targeted to provide meaningful and actionable information rather than to eliminate states’ obligations to monitor access, especially for individuals with disabilities and other vulnerable populations who are most likely to remain in FFS.