Implementation of the Ensuring Access to Medicaid Services (CMS-2442-F) Final Rule: Part 2
Payment Rate Transparency 42 CFR § 447.203(b)(2) and (3): Comparative Payment Rate Analysis Publication
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 2 – Comparative Payment Rate Analysis Publication
By July 1, 2026, in addition to states publishing their Medicaid FFS payment rate schedules as required by 42 CFR § 447.203(b)(1), states must also compare Medicaid rates for certain services to Medicare rates and publish the results on their Medicaid agency websites.
Key Comparison and Publication Requirements
- States must compare Medicaid payment rates for certain CMS-specified Evaluation and Management (E/M) codes to the corresponding Medicare rates. This includes codes associated with primary care, obstetrical and gynecological care, and outpatient mental health and substance use disorder services.
- States must perform their first comparative rate analysis for Calendar Year (CY) 2025 rates. Subsequent analyses must be updated and published at least every two years, by July 1 of the second year following the latest update.
- For the CY 2025 comparative analysis, CMS has identified a total of 68 E/M codes. CMS has published the E/M codes for the CY 2025 comparative analysis on the Medicaid.gov website.
- If Medicaid rates vary within the analysis, the state must separately identify payment rates by population (pediatric and adult), provider type, and geographical location as applicable.
- The analysis must present the Medicaid payment rate as a percentage of the Medicare non-facility rate for each specified code.
- For each code, the analysis must also include the number of Medicaid-paid claims and the number of Medicaid beneficiaries who received the service during the designated calendar year.
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 |
