Equal Access Provision
Impaired access to services for TennCare patients is more than an annoyance - it's a violation of the federal regulations that established the Medicaid program.
"A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to 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."
This provision requires states to establish payment rates adequate to assure Medicaid clients: (1) reasonable access, and (2) services of adequate quality. State Medicaid payment rates and methods of payment must be sufficient to attract enough providers so that care and services are available to the Medicaid population at least to the extent they are available to the general population in the geographic area. Rates must also be sufficient to assure quality of care.
In general, attempting to contain unnecessary health care costs is a good thing. State Medicaid programs are frequently the single-largest expenditure a state budget has in any given year. It's natural that states want to cut costs when possible; limiting payments to providers is certainly one way to improve the fiscal bottom line (at least in the short term.) However, to comply with federal law and continue to receive matching federal Medicaid dollars, the states must honor the equal access provision, or the provision should be altered accordingly.
The American Academy of Pediatrics recognizes that adequate payments are essential for health care reform.
