The Center for Medicare and Medicaid Services (CMS) will broaden the choice of providers under Medicaid. These additional providers could receive reimbursement for and provide preventive services beyond physicians and other licensed practitioners at a state's discretion. This change could be very beneficial for retail clinics and other non-primary care providers like urgent care clinics.
In a Nov. 27 bulletin, CMS said it revised language in a final rule that addressed, among other things, alternative benefit plans so that "preventive services may be provided, at state option, by practitioners other than physicians or other licensed practitioners" if recommended by a doctor or other licensed practitioner. The rule change is effective Jan. 1, and applies to preventive services, including those preventive services that receive a higher matching rate under the Affordable Care Act.
This could complicate processes to align codes with certain types of providers, but now states have the flexibility to hire providers who don't have to be licensed to get the enhanced matching rate which could be helpful. These additional providers are cost-effective for Medicaid programs.
The issue is not a top priority for all states at the moment, but it is something that states are likely to turn back to, especially as states are designing alternative benefit packages.
The CMS bulletin says that states must include in their state plan amendments which include a summary of qualifications for practitioners who aren't physicians or licensed practitioners. CMS said the summary should include required education, training, experience, credentialing or registration.