CMS Issues Guidance Letter on Right to Coverage from Qualified Providers

The U.S. Centers for Medicare & Medicaid Services (CMS) recently sent a letter to State Medicaid Directors “on protecting the right of Medicaid beneficiaries to receive covered services from any qualified provider willing to furnish such services when the state exercises its authority to take action against providers that affects beneficiary access to those providers….”  [See 42 C.F.R. 431.51(b)(1) Free choice of providers.]  Federal Medicaid dollars are prohibited from being spent on abortion services, with exceptions for cases of rape, incest, and when a woman’s life is in danger.  [See 42 U.S.C. 1397ee(c)(1) , (7)]  In the past few years, several states have restricted funding to health care facilities and Planned Parenthood that provide any type of abortion service within their range of health care services, even if that funding is not used to pay for abortion services.  [For example, see Ohio H.B. 294]  The CMS letter affirms “the ‘free choice of provider’ provision does not infringe on states’ traditional role of setting ‘reasonable standards relating to the qualifications of providers.’”  It goes on to advise “states may not deny qualification to family planning providers, or take other action against qualified family planning providers, that affects beneficiary access to those providers … solely because they separately provide family planning services or the full range of legally permissible gynecological and obstetric care, including abortion services … as part of their scope of practice.”