Medicaid beneficiaries must be able to see a behavioral health or substance use provider within 10 days of requesting an appointment, under new CMS rules.
The agency issued two final rules designed to expand access in the Medicaid fee-for-service and managed care programs on April 22.
Under the new rules, Medicaid managed care plans will need to provide members access to primary care and obstetric/gynecological care within 15 days. States will be required to conduct secret shopper studies to determine wait times and survey Medicaid members about their wait times each year.
There are not enough behavioral health providers participating in Medicaid networks to meet demand, a report from HHS' Office of Inspector General found. On average, there are 3.1 behavioral health providers that accept Medicaid patients per 1,000 beneficiaries, according to the OIG.
CMS has taken efforts to expand the number of providers available to Medicaid beneficiaries. In February, the agency said it would expand the pool of behavioral health providers eligible for enhanced Medicaid dollars to include those with Master of Social Work or other master's-level behavioral health degrees. These providers include marriage and family therapists and licensed mental health counselors.