Response to Public Comment

Medicaid Program; Methods for Assuring Access to Covered Medicaid Services
Summary of Comments and Responses Associated with Regulatory Burden

Comment: Several commenters noted that it could take a state up to 6 months and
consume many resources to conduct ongoing access reviews (in conjunction with a SPA) and
have the documentation, including rate reduction SPA documents ready to submit to CMS.
These commenters were concerned that the efforts would create a significant backlog of SPAs.
Response: As previously discussed, we have considered concerns related to the proposed
burden and have modified the ongoing regulatory requirements to reduce the burden. We also
note that the challenges presented by initial access reviews, including time constraints, were
considered in the finalizing this rule. Though initial access reviews, either triggered by the
routine, rotating review process, or by submission of a SPA, will require a significant time
investment, subsequent reviews are expected to be more manageable, due to pre-established
metrics and review mechanisms. We have conducted a regulatory impact analysis as part of this
final rule with comment period. We do not believe that there is potential for this regulation to
surpass the threshold for economic significance.