Medicaid Plan for Monitoring Access to Fee-for-Service Health Care

Access Monitoring Plan

The Department of Health Services (DHS) has published an access monitoring plan to evaluate access to health care for individuals who receive health care coverage through Wisconsin’s fee-for-service Medicaid program.

The access monitoring plan complies with a rule (CMS-2328-FC) issued on October 29, 2015, by the Centers for Medicare and Medicaid Services (CMS) that requires state Medicaid agencies to measure access to health care for individuals enrolled in the state’s fee-for-service Medicaid program using data-driven metrics, a review of fee-for-service reimbursement rates, and input from stakeholders on factors that affect access to care.

DHS developed the access monitoring plan during the first half of 2016.  A draft of the plan was published for public comment for 30 days prior to the plan being finalized.  On September 30, 2016, DHS submitted its final access monitoring plan to CMS. The final plan includes comments received during the 30-day public comment period.  DHS will update the access monitoring plan at least every three years.

Additional Details About the Access Monitoring Plan

DHS’s Division of Medicaid Services (DMS) administers Wisconsin’s Medicaid program, which provides health care coverage to over one million low-income Wisconsin residents. The Medicaid program covers a wide range of health care services, including hospital, physician, dental, behavioral health, long-term care, and others. Enrolled members receive coverage through one of two delivery systems: fee-for-service or managed care. The access monitoring plan only measures access to care under the fee-for-service delivery system. DHS separately monitors access to care under the managed care delivery system through its contracts with health maintenance organizations (HMOs).

Access to care is influenced by many complex factors, such as availability of health care providers, geography, and social factors. Given this complexity, there are no national standards for measuring access. In 2011, however, the national Medicaid and Children’s Health Insurance Program Payment and Access Commission (MACPAC) developed a generalized framework to examine major aspects of access to care, with a focus on members and their unique characteristics, availability of health care providers, and service utilization. The Medicaid Plan for Monitoring Access to Fee-for-Service Health Care relies on the structure from the MACPAC framework and is organized into five sections:

  • Overview
  • Methodology
  • Analysis
  • Stakeholder Input
  • Conclusions

Documents

Medicaid Plan for Monitoring Access to Fee-for-Service Health Care, P-01565 (PDF, 1.1 MB)

Last Revised: December 30, 2016