How New CMS Rules to Cut Appointment Wait Times Will Affect Managed Care

June 9, 2023

Research shows that new patients have to wait an average of 26 days for an appointment in 15 major US cities. To tackle this problem, the Centers for Medicare and Medicaid Services (CMS) recently proposed a rule entitled the Notice of Proposed Rulemaking Managed Care Access, Finance, and Quality (NPRM). The NPRM would cap appointment wait times for primary care, mental health, and substance use disorder treatment.

According to Nossaman LLP, “Under the proposed rulemaking, as long as states stay within CMS’s ceiling standard, they have flexibility to develop appointment wait time standards that reflect the needs of their Medicaid and CHIP managed care populations, as well as local provider availability. Each state’s maximum appointment waiting time cannot be more than 10 business days for routine outpatient MHSUD appointments and not more than 15 business days for routine primary care (adult and pediatric) and OB/GYN appointments. CMS did not propose a maximum time for the state-selected service, but requires each state to establish its own time frame in an evidence-based manner.”

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(Source: Mondaq, June 8th, 2023)

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