CMS Releases Companion Guide for States on the Medicaid Access Rule

The Centers for Medicare and Medicaid Services (CMS) released information on July 12 for states to support state compliance efforts with the Medicaid Access Rule which was finalized on May 10. The companion document clarifies regulatory intent and includes specific information on limited portions of the rule. We anticipate additional guidance on other portions of the rule in coming months.

CMS specifically targeted these details to help states with requirements to document access to care and payment rates for services and only applicable to fee for service reporting. Many of the provisions within the rule don't apply to members, such as the comparison analysis to Medicare rates- which only applies to primary care, behavioral health, and OB/GYN services. From this guidance, providers may find information included on states' obligations for rate aggregation and transparency. There are multiple useful examples of how CMS believes data should be displayed on state websites, most notably the fields that are included in templates and how comparisons are displayed. The full companion guide can be viewed here.