DE - Division of Medicaid & Medical Assistance

Document ID: CMS-2011-0062-0006
Document Type: Public Submission
Agency: Centers For Medicare & Medicaid Services
Received Date: May 27 2011, at 12:00 AM Eastern Daylight Time
Date Posted: June 2 2011, at 12:00 AM Eastern Standard Time
Comment Start Date: May 6 2011, at 12:00 AM Eastern Standard Time
Comment Due Date: July 5 2011, at 11:59 PM Eastern Standard Time
Tracking Number: 80e3425f
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This is comment on Proposed Rule

Medicaid Program: Methods for Assuring Access to Covered Medicaid Services

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Regarding the requirement to provide for payment rates that assure access to covered Medicaid servivces, it is recommended that the regulations provide states with the option to show that their payment rates fall within 5 percentage points of the state's largest commercial carrier or Medicare (give or take), and if so be deemed to have met all access standards. If states are that close to those rates, they will be providing payment at levels that are community standards. If the rates paid by the largerst carrier or Medicare can be considered to be reasonable and represent broad access to care, then Medicaid programs paying similar rates should be able to be considered as assuring that "payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area".