Families USA Submits Comments On Proposed Rule Expanding State-Directed Payment Limits

After reviewing the proposed rule, Families USA requested that the Centers for Medicare & Medicaid Services (CMS) withdraw the portions of the proposed rule that go beyond H.R.1 and retain flexibility for states to test innovative payment models across Medicaid, even if these payment rates need to exceed the Medicare rate to support Medicaid program goals.

The comment cautions that the payment limitations proposed under this Notice of Proposed Rulemaking (NPRM) are not appropriate in all settings and for all providers, nor do they always incentivize the highest-value or most cost-effective care. Furthermore, the policies proposed by CMS go beyond the statute in ways that may undermine states’ ability to ensure adequate access to care.

Rather than a rigid approach that sets blanket restrictions on the amount and types of payment mechanisms available to states, we urge CMS to take a Medicaid payment approach that ensures:

• Provider payment rates elicit a sufficient supply of providers and services for Medicaid enrollees.
• States have adequate flexibility to structure payments that give health care providers incentives to work in underserved areas, serve Medicaid patients in primary care and community settings, offer higher-value care and meet other health care system goals.
• CMS and states use data and evaluation to drive stronger metrics for Medicaid payment.
• States have an adequate level of federal Medicaid support to maintain access and quality.

Families USA encourages CMS to continue to support provider payments that work today while fostering the state innovation needed to help push the system toward value-based models in the future.