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Health organizations urge CMS not to change Medicaid Access Rule

May 23, 2018

Washington — The oral health community and Partnership for Medicaid are concerned about the Centers for Medicare and Medicaid Services' proposed changes to the Medicaid Access Rule.

In March 2016, CMS finalized new regulations creating a process for CMS to understand the extent to which access to health care is adequate in state fee-for-service Medicaid programs. The process involves states performing an access review that demonstrates how the program meets certain criteria — called an Access Monitoring Review Plan. States then submit a report of this review to CMS.

In comments filed May 22, the ADA and 43 organizations — led by Families USA and the Children's Dental Health Project — told acting CMS director Tim Hill that while they "applaud CMS for its recent focus on oral health," they are concerned about the following proposed changes:

  • The proposed exemption of dental services delivered in fee-for-service carve outs in states with a high proportion of beneficiaries in managed care (e.g., 85 percent);
  • The proposed exemption of fee-for-service dental care in cases where only a small proportion of a state's enrollees (e.g., 15 percent or less) get their dental care in fee-for-service;
  • The proposed exemption for nominal payment rate changes and the proposed modification of payment rate change state plan amendment submission information, especially as they relate to dental services.

"As we understand it, the intent of the Access Rule is to provide states, CMS and the public with information needed to understand whether a state's fee-for-service reimbursement rates are 'sufficient to enlist enough providers so that care and services are available [in Medicaid] at least to the extent that such care and services are available to the general population in the geographic area,' " the groups wrote. "Such analysis and transparency are critical in the oral health arena because utilization rates have historically been low and reimbursement rates have been shown to impact utilization rates."

The organizations reminded the agency that the Oral Health Initiative, launched in 2011, set national and state goals to increase the number of children receiving a preventive dental service from Medicaid and the Children's Health Insurance Program by 10 percentage points.

"We fully support this goal as it aligns with our goal of eradicating dental disease in children," the groups wrote. "In addition, many of our organizations are working to persuade more state Medicaid agencies to offer a dental benefit for adults because we firmly believe in the importance of oral health across the lifespan."

They also pointed out that CMS's own Oral Health Initiative data show that the efforts of CMS and the states is paying off, noting that in 2016, 46 percent of Medicaid-enrolled children ages 1-20 across the nation received a preventive dental service, up from 42 percent in 2011.

"But more improvement is needed," the organizations said. "And because dental services are included in the types of services that must be examined under the Access Rule, the [rule] can help both CMS and the oral health community achieve our respective oral health improvement goals."

The Partnership for Medicaid is also asking the Centers for Medicare and Medicaid Services to hold off on proposed changes to the agency's reporting and documentation requirements.

In comments filed May 22, the coalition told CMS administrator Seema Verma that while it recognizes the agency is seeking to ease the administrative burden for state Medicaid agencies, "we are deeply concerned by the proposed changes." The groups asked the agency to instead "fully implement the existing access requirements before proposing changes."

"Medicaid serves as a lifeline for tens of millions of Americans, and plays an important role in providing access to necessary health services that include maternity care, pediatric services, behavioral health services, primary and dental care, and long-term services and supports," wrote the Partnership for Medicaid, a nonpartisan, nationwide coalition comprising organizations representing doctors, health care providers, safety net health plans, counties and labor. "It is critical that beneficiaries access high quality, necessary services when they need them, and this is especially true for those on Medicaid who have a disability or a chronic or complex health condition. Delays in accessing needed treatments and services can lead to poorer outcomes and unnecessary costs to the health care system, and federal oversight is needed to ensure the Medicaid program is serving our nation's most vulnerable."

The coalition also said that it believes that federal and state financing of Medicaid-covered services should be sufficient to ensure that Medicaid enrollees have "timely access to high quality, necessary care" and "ensuring payments to safety net providers and plans are adequate and, where relevant, actuarially sound in order to ensure access to meet the same goal."

To read the letter in full, visit