[Medicaid] Methods for Assuring Access to Covered Medicaid Services Under 42 CFR 447.203 and 447.204 (CMS-10391)

CMS-2328-FC requires a transparent, data-driven process for states to document that Medicaid beneficiaries have access to services covered under the Medicaid State plan to the extent that services are available to the general population in a geographic area. To meet the requirements of the final rule, states must conduct access review monitoring plans that measure: the extent that enrollee needs are met, the availability of care and qualified providers, service utilization and payment rate comparisons. The reviews will be conducted every three years for: primary care, physician specialists, behavorial health, and pre and post natal obstetric services (including labor and delivery). As states reduce or restructure provider payment rates or receive significant numbers of complaints from providers and beneficiaires about access to care, additional services must be included in the review plan and monitored for at least 3 years. We are soliciting comments on the services required for ongoing access reviews and the timelines associated with review and monitoring activities. The final rule also requires states have mechanisms for obtaining beneficiary and provider feedback on access to care, such as hotlines, surveys, ombudsman or other equivalent mechanisms and institute corrective action procedures should access issues be discovered through the access review and monitoring processes. Finally, when considering reductions to Medicaid payment rates the final rule requires states to undertake a process that gathers input from stakesholds and relies upon the information analyzed through the data reveiws on the proposed reduction or restructuring of Medicaid service payment rates.

The latest form for [Medicaid] Methods for Assuring Access to Covered Medicaid Services Under 42 CFR 447.203 and 447.204 (CMS-10391) expires 2026-10-31 and is listed under ICR 202601-0938-011.

Access Monitoring Procedures Following Rate Reduction SPA (sec. 447.203(b)(6)(ii))

Federal Enterprise Architecture: Health - Health Care Services