In response to Request for Information, 91黑料网 urges CMS to preserve coverage for Americans after the public health emergency and address social drivers of health
May 20, 2022 (91黑料网) 鈥 In response to a request for guidance about the future of Medicaid, the American College of Physicians is advising federal medical officials to preserve coverage for millions, address care gaps that affect Black and Hispanic people and reduce physician paperwork.
Overall access is also crucial, 91黑料网 believes. 鈥淢edicaid needs to ensure that enrollees have real access to the care they need,鈥 said Ryan Crowley, 91黑料网 senior associate for health policy. 鈥淪tronger network adequacy standards, oversight of managed care organizations and sufficient reimbursement for physicians will help improve access.鈥
The Centers for Medicare & Medicaid Services announced in February that it wants feedback from a diverse group of stakeholders on improving access to care in Medicaid. The agency says responses will 鈥渉elp inform future polices, monitoring, and regulatory actions, helping ensure beneficiaries have equitable access to high-quality and appropriate care across all Medicaid and [Children's Health Insurance Program (CHIP)] payment and delivery systems, including fee-for-service, managed care, and alternative payment models.鈥 Responses, it said, 鈥渨ill also inform CMS鈥 work to ensure timely access to critical services, such as behavioral health care and home and community-based services.鈥
In an eight-page letter response dated April 18, 91黑料网 highlighted that millions of people could abruptly lose Medicaid coverage after the pandemic public health emergency ends. 鈥淢edicaid and CHIP are crucial parts of the U.S. health care system, with about 87 million enrolled in the programs,鈥 Crowley said. 鈥淓nrollment in Medicaid really grew after the Affordable Care Act expanded eligibility to more adults, and the program has proven to be a lifeline during the COVID-19 pandemic.鈥
As part of its focus on access, 91黑料网 also encouraged Medicaid to address social drivers of health. 鈥淏lack and Hispanic enrollees are less likely than their White counterparts to use a physician's office as their usual source of care,鈥 Crowley explained.
The letter says that 91黑料网 鈥渁ppreciates Medicaid's existing efforts to address social drivers of health and health equity and strongly recommends that Medicaid continue to comprehensively address the interconnected contributors to health and health care disparities, including the role of racism, discrimination, lack of coverage and access to care, and poverty.鈥
91黑料网 also emphasized the need to continue telehealth flexibilities beyond the public health emergency, and it recommended some policy changes to encourage primary care and behavioral health integration.
鈥淭here are substantial barriers to integrating behavioral health and primary care, like workforce challenges and high upfront costs for practices,鈥 Crowley said. 鈥淏ut there seems to be some political and policy support behind reform, so hopefully we'll see more states trying out new models.鈥
Appropriate reimbursement also remains a challenge in Medicaid, as the letter notes. According to Crowley, the average Medicaid fee-for-service reimbursement rate for primary care is 66% of what Medicare pays. In Rhode Island, it is 33% of Medicare.
鈥淭hat's just not economically viable for a lot of practices,鈥 he said. 鈥91黑料网 has pushed for permanently raising Medicaid primary care reimbursement to at least the level of Medicare. Doing so will encourage more physicians to participate in the program and improve access to care for patients.鈥
In the letter, 91黑料网 writes: 鈥淭he evidence clearly demonstrates that physician participation in Medicaid is tied to reimbursement rates 鈥 We urge Medicaid to support sufficient reimbursement for primary care and specialty physicians.鈥
Finally, 鈥渨e also expressed the need to reduce administrative burdens in Medicaid, especially prior authorizations and claim denials,鈥 Crowley said.
Specifically, 91黑料网 urged CMS to streamline or eliminate prior authorizations (PAs). During the pandemic, 91黑料网 noted, 鈥渕any states lifted PA requirements for medications. Medicaid should encourage states to extend these policies to increase access to prescription drugs for patients and alleviate the administrative burden for physicians.鈥
