CMS proposes regulatory cuts for states with high Medicaid Advantage rates

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The Centers for Medicare & Medicaid Services on Thursday issued a notice of proposed rulemaking that would ease some regulatory requirements for states offering Medicaid Advantage programs.

The proposal would exempt states from analyzing certain data and monitor access to fee-for-service plan when the vast majority of covered residents receive services through managed care plans. The proposed rule would provide similar flexibility to all states when they make reductions of 4% or less to fee-for-service payment rates.

Several advisory and advocacy groups have been pushing to make conversion to Medicaid Advantage easier for states.

Last week, MACPAC said doing so was one way to bring efficiency to the system.

States have raised concerns over undue administrative burden associated with meeting the requirements of the final rule that dates to 2015. According to the agency, some states with few Medicaid members remaining in fee-for-service programs have urged CMS to consider whether analyzing data and monitoring access in that program is a beneficial use of state resources.

“Today's proposed rule builds on our commitment to strengthening the Medicaid program and assist those it serves through state partnerships that improve quality, enhance accessibility and achieve outcomes in the most cost effective manner,” said CMS Administrator Seema Verma. “These new policies do not mean that we aren't interested in beneficiary access, but are intended to relieve unnecessary regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.”

At the same time, some patient advocates have pointed to studies that find Medicare Advantage programs often steer patients — including those in need of skilled nursing — to facilities of lesser quality. There is concern the same could happen in Medicaid Advantage programs that limit patients choice of participating providers.