MAY 04, 2023
Two Proposed Rules Would Improve Transparency of Medicaid Reimbursement Rates
The Centers for Medicare & Medicaid Services (CMS) has proposed two new rules that could have a significant impact on ophthalmology practices treating Medicaid and Children’s Health Insurance Program (CHIP) patients.
The rules would improve the transparency of Medicaid payment rates by:
- Requiring states to make all fee-for-service Medicaid payment rates public and accessible on a state website.
- Requiring states to report on their state Medicaid rates relative to comparable services with Medicare fee-for-service rates. This requirement would apply to certain service categories every two years.
The Academy sees the proposed rules as an opportunity to highlight the need for adequate payment for physicians who care for Medicaid patients, particularly those who treat children. Recent data from CMS, shows that nearly 42 million children were enrolled in Medicaid or CHIP as of January 2023. The Academy will be submitting joint comments with the American Association of Pediatric Ophthalmology and Strabismus by the July 3 deadline.
If you have questions about the rules, contact healthpolicy@aao.org.