Apr 28, 2023 - Health

CMS proposes accountability standards for Medicaid plans

Illustration of a magnifying glass examining a hundred dollar bill

Illustration: Sarah Grillo/Axios

The Centers for Medicare and Medicaid Services on Thursday proposed new reporting rules for Medicaid and the Children's Health Insurance Programs health plans, that would, among other things, set national standards for appointment wait times and require disclosure of provider payment rates.

Why it matters: The moves add transparency and accountability requirements for Medicaid managed care plans that serve the majority of program beneficiaries. They come as states begin a sweeping redetermination of Medicaid eligibility accompanying the end of the COVID public health emergency.

Details: The rules would set maximum national standards on wait times for certain appointments and require states to conduct "secret shopper" surveys to ensure compliance by health plans.

  • They would ensure that at least 80% of Medicaid payments for home health care be spent on compensation for those direct care workers, instead of on overhead or taken as profits.
  • They would require states to publish wait lists for home care services, putting numbers to long wait times residents looking for services experience.
  • And they would compel states to publish average hourly wage data for direct care workers offering services in their state.

What they're saying: The Service Employees International Union, which represents home health workers in multiple states, praised the proposals.

  • Leslie Frane, executive vice president of the union, called the proposal to ensure 80% of payments go towards worker compensation an "important step forward to make sure Medicaid dollars actually go to hands-on care."
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