On November 14, 2018, the Center for Medicare and Medicaid Services (CMS) proposed a list of changes to the Medicaid and CHIP Managed Care rule that was finalized in 2016. CHC submitted a comment letter in opposition to the proposed changes focusing on three proponents of the proposed ruling: Network Adequacy Standards, Beneficiary Information, and Notice and Appeals. Comment letters were due on January 14, 2019, and CHC’s letter can be found here.

CMS’s goal with the proposed changes is to streamline, relieve regulatory burdens, support state flexibility, local leadership, and promote transparency. However, the changes will do the opposite and limit and threaten ones access to healthcare systems and health resources across the nation.

Here are some ways in which the rule limits and threatens access to healthcare services:

Network Adequacy Standards

Currently, CMS requires states to develop network adequacy standards. Network Adequacy Standards is the time and distance it takes for one to acquire services for in-network primary and specialty care. The proposed changes would be placed in the hands of the states to develop any “quantitative standard,” as defined by each state. These changes would not affect California as much as the state has robust network adequacy standards that go over the minimum requirement. Unfortunately, these changes would affect other states that do not value healthcare as much as California. The population that would be most affected by these changes are communities of color who already deal with barriers when it comes to accessing healthcare services.

Beneficiary Information

The proposed changes threaten beneficiary information in several ways. One includes removing the requirement to update paper copies of the provider directories monthly when the health plan has a mobile-enabled online directory. This poses as an unfair problem because 36% of low-income households do not own a smartphone and of the 64% of low-income households that do own a smartphone many are not able to navigate complex health plan websites.
The proposed changes also puts in jeopardy transparency in ensuring that all individuals can understand important information related to their care. Currently, important taglines are in 18-point standard font, and the proposed changes would change the font sizes to “conspicuously-visible” rather than defined at a set standard across the nation. This may mean that individuals might inadvertently miss important information and prevent those with visual disabilities from being able to obtain information regarding their care.

Notice and Appeals

Lastly, the proposed rule seeks to make changes to the grievances and appeals process. The proposed rule wants to remove the notice requirement when the sole reason for denial is administrative, and there is no financial liability for the enrollee. Also, the rule intends to eliminate the required written confirmation of oral appeals. Not having written confirmation for motions both that positively or adversely affect a case can pose as a problem. Written confirmation can serve as proof for beneficiaries in the face a computer glitches or administrative errors.

Overall, the proposed changes eliminate transparency and fairness while putting up barriers that limit the rights of individuals to access health services.

CHC will continue to monitor and provide updates on the status and any changes that come about regarding the proposed rule changes.

Download: MedicaidRegs2019 010819_FINAL with signature (PDF)