American Osteopathic Association Issues Public Comment on Centers for Medicare & Medicaid Services Proposed Rule

Targeted News Service

WASHINGTON, Feb. 8 -- Ronald R. Burns, president of the American Osteopathic Association, has issued a public comment on the Centers for Medicare and Medicaid Services' proposed rule entitled "Medicaid Program: Medicaid Fiscal Accountability Regulation". The comment was written on Feb. 1, 2020, and posted on Feb. 4, 2020:

* * *

The American Osteopathic Association (AOA), on behalf of the more than 151,000 osteopathic physicians (DOs) and medical students we represent, wishes to share our serious concerns regarding the proposed rule "Medicaid Fiscal Accountability Regulation." While we appreciate CMS' prioritization of expanding state flexibility in program design and alleviating administrative burden, we believe that this proposed rule is contradictory to these goals and will jeopardize patient access to care. Osteopathic physicians play a critical role in our health care system, many practicing in underserved communities which have large populations of Medicaid beneficiaries. We are worried about the long-term consequences of this rule on our patients' ability to obtain vital healthcare services.

We appreciate CMS' concern for promoting financial accountability in the Medicaid program to prevent against misuse of federal matching funds to states for supplemental payments. However, the proposed rule reduces flexibilities states have in financing their Medicaid programs and distributing funds without sufficient evidence of where problems may exist. As a result, we are concerned that the rule will inappropriately cut funding to states.

Health care services and coverage must meet the needs of local populations, and states are well equipped to lead the way in innovation to help their populations. We support CMS' desire to collect data on disbursements of supplemental payments to better understand how states use these supplemental funds. However, we oppose limits on funding that are not rooted in evidence and may jeopardize state programs' ability to finance care.

In the proposed rule, CMS acknowledges that it lacks data on the use of supplemental payments. It states that none of the primary means it uses to collect information on Medicaid program eligibility, services, and expenditures "provides the level of detail on the payment and financing of supplemental payments necessary to effectively monitor and evaluate the use and impact of those payments." Similarly, a recent Senate Finance Committee report/1 found that additional provider level data is necessary for appropriate oversight of the usage of supplemental payments by states. With this in mind, we believe that several of the changes within the proposed rule that limit states' flexibility are inappropriate in light of CMS' lack of data and may have serious unintended consequences.

The AOA is especially concerned about the following elements of the proposed rule:

1. New Upper Payment Limit for Physicians

Under current regulation, physicians can receive lump sum supplemental payments from states, which often help compensate for unsustainably low base-payment rates within Medicaid programs. On average, states pay for Medicaid services at 72 percent of the Medicare rate. For primary care, the average rate is only 66 percent of the Medicare rate./2

Current CMS policy limits supplemental payments made by states to physicians at the average commercial rate. However, the proposed rule will set a new payment cap at 50% of the state's Medicaid base payment, or 75% of base payment in Healthcare Resources and Services Administration designated health professional shortage areas. In states where base rates are below the average for primary care, this will have the effect of capping payments below Medicare rates. We are concerned about the impacts these new caps may have on access to physicians and urge CMS to reconsider this proposal, especially in light of its lack of data. Such payments may often reimburse below the cost of delivering care to patients, resulting in unfair payment to physicians and placing their practices at risk.

2. State Plan Requirements for Supplemental Payments

The proposed rule seeks to strengthen federal oversight of supplemental payments by requiring that the supplemental payments be approved by CMS every 3 years as part of a state plan or state plan amendment (SPA).While this provision details the information that states must submit when seeking approval for supplemental payments, it fails to clearly outline CMS' criteria for approval. We are concerned this creates great uncertainty for states and that these provisions could be used as a means of limiting federal funding for state programs. We are especially concerned about these new requirements in light of CMS' current lack of data for effectively evaluating these payments.

Overall, the AOA is deeply concerned about the proposed rule's negative impact on states' abilities to finance and manage their Medicaid programs. Considering the lack of data on disbursement and use of supplemental payments at the provider level, we understand CMS' desire to strengthen data collection. However, we request that any new data collection requirements be minimally intrusive on providers, which can be supported by relying on data from claims. In addition, any adjustment of supplemental payment rates or limits should be postponed until CMS receives adequate data to adequately inform such adjustments. We believe that this rule is premature and will have the effect of shrinking the funds available to states, limiting access to care for the most vulnerable patients.

The AOA appreciates this opportunity to share our concerns about the potential impact of the "Medicaid Fiscal Accountability Regulation" proposed rule. If you have any questions, please contact Lisa Miller, MS, Senior Director of Regulatory Affairs and Policy Engagement at [email protected] or (202) 349-8744.

* * *

Footnotes:

1/ "Greater Transparency of Supplemental Payments Needed." Senate Finance Committee. April 30, 2019.

2/ Zuckerman, Skopec, and Epstein. "Medicaid Physician Fees after the ACA Primary Care Fee Bump" March 2017.

* * *

The proposed rule can be viewed at: https://www.regulations.gov/document?D=CMS-2019-0169-0001

TARGETED NEWS SERVICE (founded 2004) features non-partisan 'edited journalism' news briefs and information for news organizations, public policy groups and individuals; as well as 'gathered' public policy information, including news releases, reports, speeches. For more information contact MYRON STRUCK, editor, [email protected], Springfield, Virginia; 703/304-1897; https://targetednews.com