On November 2, 2015, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited final regulation implementing Medicaid’s so-called “equal access” requirement. The rule is an endgame of sorts in a legal saga that began nearly 40 years ago and that, even considering just how complicated Medicaid is, has involved an unusual number of twists and turns. The access rule takes effect on January 4, 2016 following a 60-day comment period.
Primarily a response to the United States Supreme Court’s 2015 decision in Armstrong v. Exceptional Child Center, Inc., the final rule focuses on a narrow swath of all Medicaid-financed health care and in doing so, takes modest steps toward creating a stronger evidence base and review process for evaluating the sufficiency of state Medicaid payments in relation to beneficiary access to health care. In so doing, the rule exempts much of the health care Medicaid purchases and avoids establishing national standards for defining access to care.
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