New Medicaid Guidelines Released by CMS Regarding Wait Times and Payment Standards

The Centers for Medicare and Medicaid Services (CMS) have released two final rules regarding Medicaid that are set to have a significant impact on the healthcare industry. The first rule, the Medicaid and Children’s Health Insurance Program Managed Care Access, Finance, and Quality Final Rule, establishes maximum wait times for medical care for Medicaid and CHIP beneficiaries who receive care through managed care plans. This rule sets specific wait time standards for various types of medical services, ensuring timely access to care for patients.

The second rule, the Ensuring Access to Medicaid Services Final Rule, focuses on payment standards for the direct care workforce. It requires that at least 80% of Medicaid Home and Community Based Services payments directly compensate workers rather than going towards administrative overhead. This rule aims to ensure fair compensation for healthcare workers providing essential services to Medicaid beneficiaries.

These rules mark a significant step towards improving accountability, transparency, and access to healthcare for Medicaid and CHIP beneficiaries. By setting national standards for appointment wait times and payment to healthcare workers, CMS is working to ensure that individuals have timely access to care and that workers are fairly compensated for their services.

Overall, these rules represent a positive development in the healthcare industry, aligning with President Biden’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers. The implementation of these rules will help to improve the quality of care for Medicaid and CHIP beneficiaries and create a more transparent and equitable healthcare system.