Published by: Shawn Gremminger on 5/17/2011 10:56:41 AM
“[Medicaid] reimbursement for services provided is so low that the state and the federal government are taking advantage of the altruism of the physicians providing the care. The only thing holding the system together is that altruism. It’s absolutely disrespectful of the experience and expertise these doctors have to not allow them to receive appropriate compensation for the services they provide.” – Rep. Tom Price (R-GA), Sept. 21, 2009, CQ Weekly.
“There is no easily accessible source of state payment methods, no comprehensive analysis of which are more or less effective, and no uniform data that permit meaningful comparisons of state payment levels.” – Report to Congress on Medicaid and CHIP, March 2011, prepared by the Medicaid and CHIP Payment Advisory Commission.
Section 1902 (a)(30)(A) of the Social Security Act reads, in part: State Medicaid plans shall “provide such methods and procedures relating to the utilization of, and the payment for, care and services available under the plan … as may be necessary to safeguard against unnecessary utilization of such care and services and to assure 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…”
Yet, policy makers and Medicaid experts of every stripe recognize that many Medicaid beneficiaries face a substantial barrier in finding access to care because of abysmally low Medicaid reimbursement rates for most services. Except for a handful of altruistic people, to borrow Rep. Price’s phrase, many physicians, dentists, psychologists and others simply refuse to see patients covered by Medicaid – and, when reimbursement is substantially below the cost of providing care, who can blame them? All too often, when Medicaid patients are unable to see physicians when they get sick, they ultimately come to costly hospital emergency rooms to seek primary and specialty care.
States, faced with substantial Medicaid costs, have been reducing provider payment for Medicaid for years. While they are still subject to the equal access provisions included in Sec. 1902, without proper guidance from the federal government, they have had no benchmark to determine whether their payment rates are encumbering access to care for Medicaid patients.
Finally, on May 6, the Centers for Medicare and Medicaid Services issued draft regulation that would provide specific guidance to states about how to determine whether their payment rates ensure access to care. The regulation does not set specific rates states must use, but simply requires states to use a common sense set of standards recommended by the congressionally-established, non-partisan Medicaid and CHIP Payment and Access Commission.
Unfortunately, this rule has been met with substantial resistance from various quarters in Washington who feel that the rule is overly proscriptive. Some of those who oppose the new rules are trying to have it both ways: Rightfully complaining that Medicaid does not fulfill its promise of access to care while opposing the first serious effort to ensure access in many decades.
While we agree that the rule is not perfect – we’ll be suggesting improvements in forthcoming comments – NAPH strongly approves of CMS’ action. Despite all its warts and bruises, we believe Medicaid works and we believe this rule will make Medicaid more effective in the future.