CMS’ Medicaid managed care final rule addresses access

ARLINGTON, Va. – The National Association of Chain Drug Stores hailed the Center for Medicare & Medicaid Services’ inclusion of network adequacy standards in the Medicaid and CHIP Managed Care final rule.

NACDS said Wednesday that the final rule, released on April 21, would improve patient access to care in Medicaid and the Children’s Health Insurance Program (CHIP) and represents the first major overhaul of the Medicaid and CHIP programs in over a decade.

Designed to align key rules with other health coverage programs., the final rule requires states to establish network adequacy standards in Medicaid and CHIP managed care for key providers — including pharmacies — if their services are covered under the Medicaid contract and the pharmacy network is consistent with the access standards for delivery networks.

“CMS’ decision to include a provision that ensures patients have access to pharmacy services is consistent with NACDS’ position on ensuring patients have continued access to care, which leads to better overall health outcomes and reduced costs,” NACDS president and chief executive officer Steve Anderson said in a statement. “NACDS remains committed to working with CMS as it strives to advance and improve the health care system.”

NACDS noted that it has advocated for network adequacy standards that promote access based on patients’ needs, availability of care and providers, and use of services. In response to a request from CMS, the association submitted comments last year recommending that “the final rule should include a framework that will serve as a tool to ensure that plans maintain beneficiary access to their current providers.”

In addition, NACDS said it hoped to help CMS “create standards that will serve to maintain the strong link between Medicaid patients and community pharmacies and the valuable services that these pharmacies provide.”

The effective date of the final rule is July 6, 2016, but the section specific to access to care goes into effect July 1, 2018. The rule indicates that plans won’t be held out of compliance with that requirement until July 1, 2018.