CMS Issues Final Rule to Improve Access, Accountability, and Transparency in Medicaid Managed Care

The Centers for Medicare and Medicaid (CMS) recently issued a final rule aimed at improving access to care, accountability and transparency for the more than 70 percent of Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries who are enrolled in a managed care plan. Managed care is the dominant delivery system for Medicaid enrollees.

As of July 2022, 41 states (including Washington D.C.) contract with comprehensive, risk-based managed care plans to provide care to at least some of their Medicaid beneficiaries. For the first time ever, states will be required to have national appointment wait time standards. States will enforce these wait time standards by conducting “secret shopper” surveys to help verify compliance with appointment wait time rules and correct provider directory inaccuracies.

States will also be required for the first time to disclose provider payment rates publicly. Additionally, the rule will create a new beneficiary advisory committee in every state, which will allow for direct feedback to state Medicaid and CHIP programs on benefits and service delivery from the people who access it daily.

While state Medicaid programs are required to provide hearing aid coverage for children under federal Early and Periodic Screening, Diagnostic and Treatment (EPSDT) regulations; they are not required or mandated to do so for adults (21 and older). 

At the present time, approximately thirty states provide any degree of adult hearing aid coverage. The breadth of coverage varies significantly from state to state (may not cover accessories or repairs) and is often conditioned upon the degree or severity of hearing loss. In addition, many states require prior authorization and limit the types and models of devices that are covered.