WASHINGTON – January 11, 2019 – Healthcare accreditor URAC submitted comments on January 10, 2019 in response to the Centers for Medicare and Medicaid Services’ (CMS) proposed rule for Medicaid and CHIP managed care regarding proposed changes to network adequacy requirements.
URAC supports CMS’s plans to streamline managed care regulations, enhance state flexibility, promote transparency and reduce regulatory burden. URAC is encouraged by CMS’s plan to allow states to include telehealth in their calculations to assess network adequacy but urged CMS to consider implementing a government oversight process for telehealth services to ensure quality.
Basing its recommendations on nearly three decades as a premier accreditor of managed care and provider organizations focused on quality and consumer protection, and drawing from its extensive knowledge of national network adequacy standards, URAC encourages CMS to:
- Monitor state’s efforts to contract with specialist providers as deemed appropriate to meet the needs of their respective programs and populations
- Encourage states to use a combination of qualitative and quantitative standards to ensure there are no gaps in their assessment of network adequacy
- Consider the implications of telehealth being used in lieu of in-person services
- Require states that use telehealth to calculate network adequacy to have processes in place to detect and prevent waste, fraud and abuse
“We believe CMS’s proposal rightly recognizes that telehealth is not just a supplemental benefit that should be limited to a few, but rather a key component in the management and administration of any comprehensive medical benefit,” says URAC President and CEO Kylanne Green. “While supportive of the increased flexibility given to states and the option to include telehealth when accounting for network adequacy, URAC strongly urges CMS to evaluate the potential impact of this change on patients to make sure their needs are met. We encourage CMS to use the work done by URAC to set national quality standards to validate the quality of services rendered by telehealth providers.”
Click here to download URAC’s comments to CMS in PDF format.
Founded in 1990, URAC is the independent leader in advancing healthcare quality through leadership, accreditation, measurement and innovation. URAC offers a wide range of quality benchmarking programs that reflect the latest changes in healthcare and provide a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. URAC uses evidence-based measures and develops standards through inclusive engagement with a broad range of stakeholders committed to improving the quality of healthcare. For more information, visit urac.org.
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