In September, 2016, MassHealth submitted an access monitoring review plan to the Centers for Medicare & Medicaid Services (CMS) in order to comply with a CMS regulation published on November 2, 2015.

The regulation requires each state to submit an access monitoring review plan that measures whether Medicaid members have sufficient access to care and to analyze the results of the measurements. The plan must specify data sources used to report on access measures that will address:

  • the extent to which member needs are met;
  • the availability of care and providers;
  • changes in member service utilization; and
  • comparisons between Medicaid rates and rates paid by other payers.

The access monitoring review plan must include a state review of a core set of five services:

  1. primary care,
  2. physician specialists,
  3. behavioral health,
  4. pre- and post-natal obstetrics, and
  5. home health services.

According to CMS, within the plans, each state may choose the appropriate measures, data sources, baselines, and thresholds that take into account state-specific delivery systems, member characteristics, and geography.


This information is provided by MassHealth.