Tag Archives: Medicaid rate setting

CMS Gives States Options for Complying with Cures Act Mandate to Cap Medicaid DME Rates

As previously reported, the 21st Century Cures Act prohibits federal financial participation (FFP) payments to the states for certain Medicaid durable medical equipment (DME) expenditures that exceed what Medicare would have paid for such items, either on a fee schedule basis or under competitive bidding.  The provision is effective January 1, 2018. CMS recently provided … Continue Reading

CMS Delays Deadline for State Medicaid Access Monitoring Review Plans

CMS has published a notice giving states more time to submit state access monitoring review plans under a November 2015 rule intended to assure access to covered Medicaid services.  By way of background, the final rule required states to develop and submit to CMS an access monitoring review plan for the following service categories: primary … Continue Reading

CMS Publishes Final Rule on Medicaid Fee-For-Service Ratesetting for Assuring Access to Covered Medicaid Services

On November 2, 2015, CMS published a final rule with comment period that is intended to provide a transparent, data-driven process for states to follow when they set Medicaid provider payment rates, effective January 4, 2016. Under the Social Security Act, state plans must ensure that payment rates for Medicaid services “are consistent with efficiency, … Continue Reading

CMS Proposed Rule on Methods for Assuring Access to Covered Medicaid Services

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 … Continue Reading
LexBlog