On May 6, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule to create a standardized, transparent process for states to follow when they set Medicaid payment rates. Under the Social Security Act, state plans must ensure that payment rates for Medicaid services “are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that services are available to Medicaid eligible individuals to the extent that they are available to the general population in the geographic area.” CMS points out that states currently do not have guidance on how to determine compliance with the statutory access requirements, an “issue that has come to light recently, both in litigation and in our review of proposed Medicaid State plan amendments (SPAs) that would reduce provider payment rates.” CMS therefore is proposing to clarify the definition of access to care and services and provide standard data elements and measures that states must submit to CMS to demonstrate that payment rates are sufficient to provide access to covered Medicaid services.  If a state proposes provider rate reductions or restructuring that could result in access issues, the state would be required to conduct an “access review” using a three-part framework recommended by the Medicaid and CHIP Payment and Access Commission (MACPAC). The elements of the MACPAC framework that must be addressed are: the extent to which enrollee needs are met, the availability of care and providers, and changes in beneficiary utilization of covered services. The review also would include a comparison of Medicaid payment rates to customary charges and Medicare, commercial payments, or provider cost. In addition, the proposed rule would require that states develop monitoring procedures after implementing provider rate reductions or restructuring rates in ways that may negatively impact access to care. The rule also would recognize, as states have requested, electronic publication as an optional means of communicating to the public information about SPAs with proposed rate-setting policy changes. CMS will accept comments on the rule until July 5, 2011.