09/30/2024 | Press release | Archived content
States are not leveraging managed care provider coverage requirements and network adequacy standards to promote access to maternal health care. Access to maternal health care can support better health outcomes.
All States require their MCOs to cover obstetrician/gynecologist (OB/GYN) physicians and hospitals, but many States reported they do not require MCOs to cover other important types of maternal health providers and professionals, some of whose services are federally required.
Some States are not using network adequacy standards to address important dimensions of maternal health care access. For example, some States measure access to specific provider types such as OB/GYNs, but many States do not. Some States tailor their standards to maternal health care (e.g., by varying appointment wait time requirements by stage of pregnancy), while others do not.
All States reported monitoring MCOs' compliance with network adequacy standards, but they may lack data on the standards' impact on enrollees' access to maternal health care.
OIG recommends that CMS:
CMS concurred with all three recommendations.
This report may be subject to section 5274 of the National Defense Authorization Act Fiscal Year 2023, 117 Pub. L. 263.