Federal regulations at 42 CFR 447.203 and 447.204, implementing section 1902(a)(30)(A) of the Social Security Act (the Act), describe procedures for states and territories to follow in order to document that Medicaid payment rates are sufficient to enlist enough providers so that care and services are available under the state plan at least to the extent that such care and services are available to the general population in the geographic area. Through Access Monitoring Review Plans (AMRPs), states are required to analyze data and supporting information to reach conclusions on sufficient access for covered services provided under fee-for-service. Every three years, states must conduct the analysis for: primary care services (including those provided by a physician, FQHC, clinic, or dental care); physician specialist services; behavioral health services, including mental health and substance use disorder; pre- and post-natal obstetric services, including labor and delivery; and home health services. States are required to include additional services within the AMRPs when proposing to reduce rates or restructure payments in ways that may harm access to care and describe procedures to monitor access over three years once the reductions are approved. The AMRPs, and subsequent additions to the AMRPs, are developed in consultation with a state’s Medical Advisory Committee and subject to a 30 day public comment period prior to submission to the Centers for Medicare & Medicaid Services (CMS).
States submitted the first round of AMRPs to the CMS on October 1, 2016. The AMRPs are reviewed, but not formally approved, by CMS and are used to determine compliance with the Act as part of the State plan amendment review process. The AMRPs below are the “as submitted” plans received by CMS from states for the first submission period. CMS will update the documents as states amend them for purposes of analyzing and monitoring services subject to rate reductions.
Information contained below is gathered by CMS with assistance from States. If any information is incorrect, please send an email to MedicaidAccesstoCare@cms.hhs.gov.
Persons with disabilities having problems accessing the PDF files may call 410-786-0429 for assistance.
State | Access Monitoring Review Plans | Public Notice |
---|---|---|
Alabama | Alabama Access Monitoring Review Plan (PDF, 1.03 MB) | Public notice not available |
Alaska | Alaska Access Monitoring Review Plan (PDF, 553.47 KB) | Public notice not available |
Arizona | Arizona Access Monitoring Review Plan (PDF, 314.94 KB) | Public notice not available |
Arkansas | Arkansas Access Monitoring Review Plan (PDF, 2.75 MB) | Public notice not available |
California | California Access Monitoring Review Plan (PDF, 4.48 MB) | Public notice not available |
Colorado | Colorado Access Monitoring Review Plan (PDF, 8.6 MB) | Public notice not available |
Connecticut | Connecticut Access Monitoring Review Plan (PDF, 1.76 MB) | Public notice not available |
Delaware | Delaware Access Monitoring Review Plan (PDF, 810.06 KB) | Public notice not available |
District of Columbia | District of Columbia Access Monitoring Review Plan (PDF, 3.54 MB) | Public notice not available |
Florida | Florida Access Monitoring Review Plan (PDF, 1.14 MB) | Public notice not available |
Georgia | Georgia Access Monitoring Review Plan (PDF, 1.2 MB) | Public notice not available |
Guam | Guam Access Monitoring Review Plan (PDF, 195.69 KB) | Public notice not available |
Hawaii | Hawaii Access Monitoring Review Plan (PDF, 101 KB) | Public notice not available |
Idaho | Idaho Access Monitoring Review Plan (PDF, 686.12 KB) | Public notice not available |
Illinois | Illinois Access Monitoring Review Plan (PDF, 693.4 KB) | Illinois Public Notice |
Indiana | Indiana Access Monitoring Review Plan (PDF, 1.7 MB) | Indiana Public Notice |
Iowa | Iowa Access Monitoring Review Plan (PDF, 501.48 KB) | Iowa Public Notice |
Kansas | Kansas Access Monitoring Review Plan (PDF, 249.21 KB) | Public notice not available |
Kentucky | Kentucky Access Monitoring Review Plan (PDF, 175.07 KB) | Public notice not available |
Louisiana | Louisiana Access Monitoring Review Plan (PDF, 747.02 KB) | Public notice not available |
Maine | Maine Access Monitoring Review Plan (PDF, 607.77 KB) | Public notice not available |
Maryland | Maryland Access Monitoring Review Plan (PDF, 740.15 KB) | Public notice not available |
Massachusetts | Massachusetts Access Monitoring Review Plan (PDF, 410.62 KB) | Public notice not available |
Michigan | Michigan Access Monitoring Review Plan (PDF, 690.4 KB) | Michigan Public Notice |
Minnesota | Minnesota Access Monitoring Review Plan (PDF, 2.07 MB) | Public notice not available |
Mississippi | Mississippi Access Monitoring Review Plan (PDF, 1.13 MB) | Public notice not available |
Missouri | Missouri Access Monitoring Review Plan (PDF, 1.58 MB) | Public notice not available |
Montana | Montana Access Monitoring Review Plan (PDF, 1.33 MB) | Montana Public Notice |
Nebraska | Nebraska Access Monitoring Review Plan (PDF, 2.18 MB) | Nebraska Public Notice |
Nevada | Nevada Access Monitoring Review Plan (PDF, 585.69 KB) | Public notice not available |
New Hampshire | New Hampshire Access Monitoring Review Plan (PDF, 1.74 MB) | Public notice not available |
New Jersey | New Jersey Access Monitoring Review Plan (PDF, 467.97 KB) | Public notice not available |
New Mexico | New Mexico Access Monitoring Review Plan (PDF, 1.53 MB) | Public notice not available |
New York | New York Access Monitoring Review Plan (PDF, 933.28 KB) | Public notice not available |
North Carolina | North Carolina Access Monitoring Review Plan (PDF, 1.49 MB) | Public notice not available |
North Dakota | North Dakota Access Monitoring Review Plan (PDF, 6 MB) | North Dakota Public Notice |
Ohio | Ohio Access Monitoring Review Plan (PDF, 19.63 MB) | Public notice not available |
Oklahoma | Oklahoma Access Monitoring Review Plan (PDF, 6.23 MB) | Public notice not available |
Oregon | Oregon Access Monitoring Review Plan (PDF, 768.05 KB) | Public notice not available |
Pennsylvania | Pennsylvania Access Monitoring Review Plan (PDF, 688.58 KB) | Public notice not available |
Rhode Island | Rhode Island Access Monitoring Review Plan (PDF, 436.05 KB) | Public notice not available |
South Carolina | South Carolina Access Monitoring Review Plan (PDF, 2.89 MB) | Public notice not available |
South Dakota | South Dakota Access Monitoring Review Plan (PDF, 938.11 KB) | Public notice not available |
Texas | Texas Access Monitoring Review Plan (PDF, 471.97 KB) | Public notice not available |
Utah | Utah Access Monitoring Review Plan (PDF, 1.58 MB) | Public notice not available |
Virgin Islands | Virgin Island Access Monitoring Review Plan (PDF, 611.55 KB) | Public notice not available |
Virginia | Virginia Access Monitoring Review Plan (PDF, 5.06 MB) | Public notice not available |
Washington | Washington Access Monitoring Review Plan (PDF, 4.18 MB) | Public notice not available |
West Virginia | West Virginia Access Monitoring Review Plan (PDF, 1.26 MB) | West Virginia Public Notice |
Wisconsin | Wisconsin Access Monitoring Review Plan (PDF, 1.48 MB) | Public notice not available |
Wyoming | Wyoming Access Monitoring Review Plan (PDF, 1.07 MB) | Public notice not available |
Urban Report
On November 2, 2015, CMS issued the Request for Information (RFI): Data Metrics and Alternative Processes for Access to Care in the Medicaid Program to inform the potential development of standards with regard to Medicaid beneficiaries’ access to covered services under the Medicaid program. CMS solicited information on four specific topic areas: 1) developing a core set of measures of access that all states would monitor and publicly report on in the state’s access monitoring review plan; 2) measuring access to long term care and home and community based services; 3) setting national access to care thresholds; and 4) establishing a process that would allow beneficiaries experiencing access issues to raise and seek resolution of their concerns. To help analyze the responses to the RFI, CMS engaged the Urban Institute to develop a report entitled “Proposed Medicaid Access Measurement and Monitoring Plan (PDF, 1.01 MB).” Through their efforts, the Urban Institute identified readily available data elements currently in use by CMS and states through other programs, initiatives, and resources that may be used to measure access to care, such as the Adult and Child Core Set, Consumer Assessment of Healthcare Providers and Systems (CAHPS), and the Healthcare Effectiveness Data and Information Set (HEDIS). CMS is making the final report available as a technical assistance tool for states. The report is for informational purposes and the framework described within is not mandated.