On November 2, 2015, the federal Centers for Medicare and Medicaid Services (CMS) published a final rule implementing the equal access provision that requires state Medicaid agencies to develop a medical assistance access monitoring review plan. The review plan must consider:
- The extent to which beneficiary needs are fully met;
- The availability of care through enrolled providers to benficiaries in each geographic area, by provider type and site of service;
- Changes in benficiary utilization of covered services in each geographic area;
- The characteristics of the beneficiary population (including considerations for care, service and payment variations for pediatric and adult populations and for individuals with disabilities); and
- Actual or estimated levels of provider payment available from other payers, including other public and private payers, by provider type and site of service.
Effective January 4, 2016, the new rule requires states to develop review plans and update them periodically. States must make plans available to the public for at least 30 days, finalize them, and submit them to CMS for review. The first plan was due by October 1, 2016.
The final rule excludes access reviews for Medicaid managed care arrangements.
In further efforts to provide comparable access to that which is provided to non-Medicaid enrollees, and in accordance with 42 CFR 447.203, DMHF has developed an Access Monitoring Review Plan (AMRP) for the following service categories provided under a Fee for Service (FFS) arrangement:
- Primary care services
- Physician specialist services
- Pre- and post-natal obstetric services, including labor and delivery
- Home health services
The Utah AMRP can be found on this website and includes a standardized, data-driven process by which DMHF documents and monitors access to care; taking into consideration the extent to which beneficiary needs are met, the availability of care and providers, utilization of Medicaid services, and a comparison of Medicaid rates paid by other payers in the market.