Access Monitoring Review Plan

Federal law requires state Medicaid programs to ensure that Medicaid beneficiaries can access services to at least the same extent as the general population in the same area. The Centers for Medicare & Medicaid Services (CMS) recently issued a final rule implementing this equal access provision. The rule sets new requirements for states to create a data-driven process and plan to monitor and review access to services for fee-for-service enrollees in Medical Assistance, as compared to the general population.

In accordance with this rule, the Minnesota Department of Human Services (DHS) developed an access monitoring review plan for the following service categories:

• Primary care
• Dental care 
• Physician specialist
• Pre-and post-natal obstetric services 
• Behavioral health services 
• Home health.

Minnesota’s plan considers the following for each of the listed services:

• The extent to which beneficiary needs are fully met; 
• The availability of care through enrolled providers to beneficiaries in each geographic area, by provider type and site of service; 
• Changes in beneficiary use of covered services in each geographic area; 
• The characteristics of the beneficiary population (including considerations for care, service and payment variations for pediatric and adult populations, and for individuals with disabilities); and 
• Actual or estimated levels of provider payment available from other payers, including other public and private payers, by provider type and site of service. 

DHS submitted the Access Monitoring Review Plan to CMS on Sept. 30, 2016.