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Medicaid directors to CMS: Don't standardize access-to-care measures

Letter says telemedicine initiatives, unique state characteristics make top-down approach 'inappropriate'

Medicaid directors want the federal government to work with states to determine access-to-care measures in the program--measures they say should account for factors such as telemedicine initiatives and varying provider capacity in different geographies.

In a letter sent this week to the Centers for Medicare & Medicaid Services, the National Association of Medicaid Directors (NAMD) said it would be "inappropriate" for CMS to set standard thresholds for access to care in the government insurance program for low-income individuals. Such an approach, the NAMD said, would limit states' ability to set access thresholds that incorporate the nuances of their respective healthcare landscapes.

CMS-identified indicators such as appointment times, wait times and call center times provide a "reasonable framework" for measuring access to care, according to the NAMD, but the agency shouldn't prescribe the same federal benchmarks for states as diverse as New York and Alaska, for example.

What's more, "measures should be nimble enough so as to keep pace with evolving technology and innovations that states and providers may leverage to facilitate access, particularly for specialty services" such as behavioral health, the letter states. Private insurers such as Anthem, UnitedHealth and Cigna, as well as Aetna and startup Oscar Health, are increasingly embracing telemedicine through partnerships with private companies like Teledoc.

Medicaid is not the only government program that some claim is hampering the use of technology in patient care. This fall, industry stakeholders asked the Senate to lift "outdated restrictions" on telemedicine reimbursement in the Medicare program while the Medicare Access and CHIP Reauthorization Act is being implemented.

In the letter to CMS, state Medicaid directors also expressed concern about the possibility of comparing Medicaid payment rates with private insurers and Medicare. These payers all cover substantially different populations, the NAMD noted, and commercial insurers often consider such payment rates proprietary. In addition, the NAMD said the authority to determine reimbursement rates should lie primarily with state Medicaid agencies.

To learn more:
- here's the letter

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