Access to care provision part of CMS’ Medicaid managed care final rule

ARLINGTON, Va. – The National Association of Chain Drug Stores on Wednesday praised the Center for Medicare & Medicaid’s inclusion of network adequacy standards — which would improve patient access to care in Medicaid and the Children’s Health Insurance Program — in the Medicaid and CHIP Managed Care final rule the agency released on April 21.

 

“CMS’ decision to include a provision that ensures patients have access to pharmacy services is consistent with NACDS’ position on ensuring patients have continued access to care, which leads to better overall health outcomes and reduced costs,” stated Steven Anderson, NACDS president and CEO. “NACDS remains committed to working with CMS as it strives to advance and improve the healthcare system.”

 

The final rule marks the first major overhaul of the Medicaid and CHIP programs in more than a decade, and seeks to align key rules with other healthcare coverage programs. In order to strengthen access to care, the final rule requires states to establish network adequacy standards in Medicaid and CHIP managed care for key providers — including pharmacy — if their services are covered under the Medicaid contract, and the pharmacy network is consistent with the access standards for delivery networks.

 

NACDS has consistently advocated for network adequacy standards that promote access based on patients’ needs, availability of care and providers and utilization of services. In response to a request from CMS, NACDS submitted comments in 2015 recommending that “the final rule should include a framework that will serve as a tool to ensure that plans maintain beneficiary access to their current providers.” 

 

In addition to establishing a framework, NACDS said it hoped to help CMS “create standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide.”

 

Of note, the effective date of the rule is July 6, 2016, however the section specific to access to care is effective July 1, 2018. The final rule indicates that plans will not be held out of compliance with this requirement until July 1, 2018.