CMS seeks feedback on using out-of-state providers for Medicaid-covered children


The CMS wants information on the best tactics to deploy when providers in other states care for medically complex children insured by Medicaid.

Congress required the CMS to post the request for information, which was released Thursday, through the Medicaid Services Investment and Accountability Act of 2019. The law allows state Medicaid agencies to cover home health services for medically complex children, but it also requires participating states to include how they are going to track “prompt and timely access” to out-of-state providers if they care for those children. The law will go into effect Oct. 1, 2022.

Sometimes children with complex chronic conditions such as cystic fibrosis, cerebral palsy or spina bifida don’t have access to relevant physicians, hospitals or practices in their home states. The Medicaid program allows families to receive care out of the state if necessary, requiring the state pay for those services as if it occurred in the home state.

The CMS is requesting information from primary care physicians, pediatricians, hospitals and other entities that provide care to Medicaid-insured medically complex children about how to best coordinate their care if it’s done out-of-state. The agency is asking for specific examples of tactics that have worked and those that haven’t.

The CMS also wants to know the barriers, including financial ones, that prevent families from receiving care from out-of-state providers promptly and the challenges for caregivers who provide those services.

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