On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a final rule titled: Medicaid and Children’s Health Insurance Program (CHIP) Ensuring Access to Medicaid Services (CMS-2442-F). The final rule rescinds the existing access monitoring review plan (AMRP) requirements at 42 CFR § 447.203(b) and replaces it with new requirements around Medicaid fee-for-service (FFS) payment rate transparency.

The intended purpose of the new requirements is to ensure State compliance with the Section 1902 (a)(30)(A) of the Medicaid statute. Specifically, states must “assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.”1

The final rule requirements address this intent by:

• Increasing Medicaid FFS payment rate transparency, standardizing state data and information requirements, and decreasing state administrative burden though targeted rate review.
• Offering greater clarity into how Medicaid payment levels affect beneficiary access to care.
• Providing data to CMS to demonstrate that any provider rate reductions or restructuring will not harm beneficiary access to care.