Congress Sends Plea to HHS to Issue Medicaid Equal Access Regulations

Thursday, July 16, 2015
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The House Committee on Energy and Commerce and the Senate Committee on Finance both recently sent a letter to Secretary Burwell urging the U.S. Department of
Health and Human Services (HHS) to actually issue the Medicaid Equal Access regulations. The regulatory guidance was proposed by the Centers for Medicare and Medicaid Services (CMS). The document is entitled Medicaid Program: Methods for Assuring Access to Covered Medicaid Services, 76 Fed. Reg. 26,342 (May 6, 2011).

The Congressional letter was sent on June 23, four years after the passage of legislation required the regulations to be implemented. To read the letter, click here.

Equal Access Regulations are Important.

The Equal Access provision is critically important because more and more citizens are gaining Medicaid benefits. Over the years, states have made drastic provider payment reductions because of budget constraints. Medicaid providers have filed lawsuits to help keep the pressure on states so they don’t make such drastic reductions to provider rates without considering how it would affect the enrollee’s access to care.

These provisions are extremely important to Medicaid beneficiaries, since court cases have eroded their right to sue. The regulations that are supposed to be written would put some real teeth into HHS’s review of states’ payment decisions on equal access to care for Medicaid beneficiaries. They would ensure that HHS is actively overseeing states’ payment rate decisions.

According to the draft, the proposed rules would “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.” To read the document, click here.

This request is an important call for action in the wake of Armstrong v. Exceptional Child Center. This case eliminated private rights of action for Medicaid providers who wanted fair reimbursement from states in federal courts.

The letter acknowledges the harm the Court’s recent decision will have on Medicaid.

The draft regulations were not perfect, but they ensure that HHS is overseeing states’ payment rate decisions. States are able to modify rates without much intervention from HHS. This involves decreasing payment rates to balance state budgets. Because the court has now tasked HHS with enforcing the equal access provision, HHS must complete the draft regulations.


What do you think about the Committee plea for action? Do you feel the regulations should be issued? Please leave any thoughtful comments below.

Contact a Health Care Attorney Experienced with Medicare and Medicaid Cases.

Attorneys with The Health Law Firm represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program. We also handle Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S.

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Armstrong v. Exceptional Child Center, No. 14-15, slip op. From:

Federal Register. “Proposed Rules,” Vol. 76, No. 88. (May 6, 2011). From:

Huberfeld, N. “Congress, too, is mystified by long-delayed Equal Access regs.” (June 23, 2015). From:

Letter from House of Representatives to Sylvia Burwell (June 22, 2015). From:

State Plans for Medical Assistance, 42 U.S. Code § 1396a. From:

About the Author:
George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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