"CMS finalized the long-awaited Medicaid access rule last fall, requiring states to more carefully monitor access to care in fee-for-service Medicaid. States must post their draft plans for public comment for at least 30 days before submitting them to CMS - so the time is now to comment on your state's draft plan. The plan must identify a data-driven procedure to review access to care that addresses the extent to which beneficiary needs are fully met, the availability of care through enrolled providers, and changes in beneficiary service utilization. The plan must also show aggregate comparisons between Medicaid provider payment rates and rates paid by other public and private payers.
"The plan will govern regular access reviews for certain services, including: primary care, physician specialist, behavioral health, pre- and post-natal obstetric, and home health care. States must use the information gathered in the reviews to determine the sufficiency of access to care, which may vary geographically within the state. States must also consider real-time information from providers and beneficiaries gathered through ongoing feedback mechanisms. CMS will review and evaluate state-submitted access reports annually.
"It is important that child advocates review their state draft plans and submit comments because CMS will expect states to take those comments into account and improve their plans before finalizing them. Start today by going to your state's website to find the posted plan and checking it out. You may find that the state plan does not adequately address access to pediatric services and if so, your comments to improve it will be critical.
You can find Indiana's rule here (or embedded below)
Pursuant to 42 CFR Sections 447.203 through 447.205, Indiana Medicaid is required to post the Access Monitoring Review Plan for public comment and review. A public comment period will be available from September 1 through September 30, 2016. Comments may be provided through the following methods:
State of Indiana
Family and Social Services Administration
Office of Medicaid Policy and Planning
Attn: Provider Relations
402 W. Washington Street, Room W374, MS07
Indianapolis, IN 46204