Ensuring Access to Medicaid Services

On May 10, 2024, the Centers for Medicare and Medicaid Services (CMS) published the Ensuring Access to Medicaid Services Final Rule, 89 FR 40542 (“2024 Access Final Rule”). This rule aims to increase transparency and accountability, standardize data collection and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs. To achieve these goals, the rule includes three main subsections, two of which address Documentation of Access to Care and Service Payment Rates.

Consistent with the Access Final Rule requirements for Documentation of Access to Care and Service Payment Rates (42 CFR 447.203), state Medicaid programs are required to maintain documentation related to access to care and service payment rates. Specifically, the state agency is required to document the following.

• Maintain payment rate transparency by publishing all Medicaid fee-for-service (FFS) fee schedule payment rates
• Develop a comparative payment rate analysis for (1) primary care services, (2) obstetrical & gynecological services, (3) outpatient mental health & substance use disorder services, (4) personal care, home health aide, homemaker, and habilitation services that:
  • Compares the Medicaid FFS fee schedule rates Medicare rates for CMS specified evaluation and management (E/M) codes
  • Specifies the number of Medicaid-paid claims and the number of Medicaid enrolled beneficiaries who received the service within a calendar year

Consistent with 42 CFR 447.230(b)(2) and (3), the following analysis compares CT Medicaid FFS rates with the Medicare rate for specified procedure codes. This analysis also includes the number of Medicaid-paid claims and the number of Medicaid-enrolled beneficiaries who received each service within a calendar year. The procedure codes and calendar year used are consistent with the final rule requirements and this analysis will be updated every two years.