Implementation of the Ensuring Access to Medicaid Services (CMS-2442-F) Final Rule: Part 1
Payment Rate Transparency 42 CFR § 447.203(b)(1): Payment Rate Transparency Publication of Medicaid FFS Rates
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). As we previously summarized in our May 2024 client alert, the final rule rescinds the existing access monitoring review plan (AMRP) requirements at 42 CFR § 447.203(b) and replaces them with new requirements for Medicaid fee-for-service (FFS) payment rate transparency.
To assist states in complying with these requirements, in July 2024, CMS published a Guide for States titled Ensuring Access to Medicaid Services – A Guide for States to the Fee-For-Service Provisions of the Final Rule. The Guide for States outlines comprehensive instructions relating to these requirements. We have included below a table from the Guide outlining the key provisions and applicability (compliance) dates.
| Part | Regulation Section(s) in Title 42 of the CFR | Applicability Dates* |
| 1 | Payment Rate Transparency Publication § 447.203(b)(1) | July 1, 2026, then updated within 30 days of a payment rate change. |
| 2 | Comparative Payment Rate Analysis Publication § 447.203(b)(2) to (4) | July 1, 2026, then every 2 years |
| 3 | Payment Rate Disclosure § 447.203(b)(2) to (4) | July 1, 2026, then every 2 years |
| 4 | Interested Parties Advisory Group § 447.203(b)(6) | The first meeting must be held within 2 years after effective date of the final rule, then at least every 2 years. |
| 5 | Rate Reduction and Restructuring SPA procedures § 447.203(c)(1) and (2) | July 9, 2024 |
This Client Alert Addresses Part 1 – Payment Rate Transparency Publication
The final rule promulgated new regulatory provisions at 42 CFR § 447.203(b)(1) that requires state Medicaid agencies to publish and make readily accessible all fee-for-service (FFS) rate schedules on a public-facing website by July 1, 2026. Many states are compliant with some aspects of this regulation because they currently publish FFS rates schedules on their Medicaid websites. However, 42 CFR § 447.203(b)(1), and the July 2024 CMS guidance document include specific requirements regarding the content and coverage of fee schedule publications that will be new to most states. Therefore, it is crucial for states to act now to thoroughly review their FFS payment rate schedules to ensure compliance with the regulation.
Key Requirements
- Accessibility: Rates must be organized in a manner that allows the public to easily understand the Medicaid FFS payments. This includes all FFS rates, including rates state may not have historically published, such as provider-specific rates. Note that the publication requirements exempt FQHC and RHC rates as well as CCBHC rates under the CCBHC demonstration.
- Bundled and Value-Based Payments: States must identify each component service within bundled and value-based payments if based on FFS rates, along with their respective rates and allocations. Certain alternative payment methodologies may also be subject to publication requirements.
- Formula-Based Methodologies: States must publish the actual payment amounts derived from any formula-based methodologies.
- Variable Rates: FFS rates that vary based on population (e.g., pediatric vs. adult), provider type, geographic location, or other factors must be clearly identified in each fee schedule publication.
States have the flexibility to organize and format their FFS rate publications as long as these requirements are met. Compliance may necessitate updates to fee schedule templates, changes in state operational procedures, or modifications to websites and posting policies. Additionally, once states meet the July 1, 2026 deadline, they must update the rate publication within 30 days of all approved rate changes.
Recommended State Actions
Myers and Stauffer recommends that states act now to prepare for meeting the Payment Rate Transparency Publication regulation. Our experienced team is available to assist with the following:
- Evaluate Payment Rate Transparency Requirements. Review the Final Rule and CMS Guide for States on the FFS provisions to understand the numerous new requirements for rate publication.
- Perform a Gap Assessment. Identify gaps in published rates. This may include:
- Currently unpublished rates, such as hospital or nursing facility rates. Many states do not currently publish provider-specific rates such as institutional provider rates.
- Rate types that are currently published but need modification to meet the new requirements. For example, publishing rate differentials by population (pediatric and adult), provider type, and geographic location.
- Rate bundles that need to be dis-aggregated. This applies to bundled payment rates that are based on fee schedule payment rates for each constituent service.
- Engage with Stakeholders. Identify impacted state stakeholders, such as state reimbursement departments/teams, impacted MMIS and rate setting vendors, etc.) and form a team to review fee schedules and identify necessary changes for compliance. In addition, consider the impact on providers and other stakeholders of publishing rates that have not previously been published. States may want to engage impacted providers prior to publication to ensure awareness.
- Engage with CMS, if necessary. Submit questions or comments to CMS as soon as possible.
- Set Procedures. Develop procedures for updating, quality reviewing, and publishing fee schedules for initial and ongoing regulatory compliance. States should consider the following:
- Identify the website for rate publication, i.e., state agency website, MMIS vendor website, rate setting contractor website, etc. Contractor websites can be used if they are hyperlinked from the state agency website.
- Identify the date each rate was last updated and include the date with the published rates. States are not required to research historical rate effective date information but can use the date of publication as the date of the last update. The date provides assurance that the rates on the website are current as of that date.
- Develop a routine process to update rates every two years, with the second update occurring 7/1/2028.
- Evaluate opportunities to improve rate publication, through consolidating fee schedules, improving fee schedule format/layout/readability, and access for individuals with disabilities (508 compliance and related state requirements).
How Myers and Stauffer Can Help
Myers and Stauffer has nearly 50 years of Medicare and Medicaid knowledge about required principles that must be followed to set rates and develop payment systems. For many of our rate setting engagements, our procedures include calculating reimbursement rates, developing rate schedules for publication, preparing comparisons to Medicare, facilitating stakeholder engagement, and other activities that support accurate and transparent reimbursement rates. Our experienced team is ready to support states in ensuring timely compliance with the federal rate transparency requirements.
| Tim Guerrant, CPA Member |
Jared Duzan, CFE Member |
Joe Gamis, CFE, MBA Principal |
| Jeffery Marston Member |
Daniel Brendel Principal |
Tara Clark, CPA Member |
| John Dresslar, CPA Member |
Bobby Courtney, MPH, JD Principal |
Megan Frenzen, MBA, MSc, PhD Principal |
| Scott Price, CPA, CFE, PMP, CGMA Member |
Krista Stephani, CPA Member |
