Physicians say Medicaid managed care rule ignores low doctor pay

The new regulation fails to address the problem of ensuring adequate physician participation in Medicaid.

By Amy Snow Landa, AMNews staff. Nov. 12, 2001.

Washington -- In its comments on the new Medicaid managed care rules proposed by the Bush administration, the AMA underscores the need to ensure that an adequate number of physicians remain willing and able to treat Medicaid patients.

For years, physicians have tried to make the case that low Medicaid reimbursement rates make it difficult for physicians to stay in the program.

A lack of sufficient physician participation, in turn, hurts Medicaid beneficiaries' access to high-quality care, the AMA emphasized. "But the current rule does not even acknowledge this problem, let alone address it."

The AMA submitted comments Oct. 19 in response to the Health and Human Services Dept.'s August announcement that it would modify rules by the Clinton administration to give Medicaid beneficiaries in managed care plans new patient protections. The Clinton rules were scheduled to take effect in April but were twice delayed. HHS Secretary Tommy Thompson says he expects to have the new rules in place by early next year.

In revising the Clinton rules, HHS has come under fire from consumer groups and congressional Democrats -- both for delaying implementation of the new patient protections and easing requirements on Medicaid managed care plans, particularly in the area of grievances and appeals.

The AMA and other physician groups, which have a number of concerns about the proposed rule, submitted their comments in October to Centers for Medicare & Medicaid Services Administrator Tom Scully. [...]