On June 1, 2015, the Department of Health and Human Services, Centers for Medicare and Medicaid Services’ (“CMS”) published a proposed rule that seeks to improve health care coverage for millions of people.
In response to this proposed rule, we partnered with Duane Morris LLP to provide comments on behalf of our client, Public Citizens for Children and Youth (“PCCY”).
PCCY works to improve the lives of children in southeast Pennsylvania by developing initiatives and advocating for quality health care, child care, public education and family stability.
While we generally support the proposed rule, we have concerns regarding the transparency provision, medical loss ratio provisions, CMS’s “in lieu of” policy, and time and distance standards.
As we wrote in the comments, “The proposed regulation allows wide flexibility for states by requiring them to develop and enforce their own specific network adequacy standards. As we have interpreted the regulation, states would not be required to set specific provider-beneficiary ratios, but rather must develop time and distance standards for primary care and other provider types. While we recognize this approach is consistent with CMS’ general approach for the Medicaid program, we are concerned that time and distance standards will have limited practical effect in establishing and maintaining network adequacy. This is particularly true given the states’ historical lackluster performance and enforcement of network adequacy standards.”
We urge CMS to strongly consider our comments to strengthen the proposed rule and Medicaid health care coverage.