Improving access and quality in Medicaid | Healthy Bottom Line podcast

Gary Jessee says that Medicaid is his passion.

Gary Jessee is the senior vice president of Sellers Dorsey’s National Medicaid Consulting Practice.

Jessee is the senior vice president of Sellers Dorsey’s National Medicaid Consulting Practice. He’s spent a long career as a former Medicaid director. Before joining Sellers Dorsey, Jessee served as the deputy executive commissioner for Medical and Social Services in Texas, the largest division in the state’s Health and Human Services System, where he oversaw a $50 billion budget.

Earlier this year, the Centers for Medicare & Medicaid Services introduced a new rule aimed to boost access and quality in Medicaid and the Children’s Health Insurance Program. He talked about the final rule in the latest installment of “Healthy Bottom Line,” a podcast from Chief Healthcare Executive®.

“What you're seeing is a goal by our federal partners to ensure consistency and design and delivery across the country,” Jessee says.

The CMS says it wants to build stronger managed care programs, since 70% of Medicaid and CHIP beneficiaries receive all or at least some of their care through a managed care plan.

With the rule unveiled in the spring, CMS establishes some standards for maximum appointment wait times. The standards call for a maximum of 15 business days for routine primary care and obstetric/gynecological services, and 10 business days for outpatient mental health and substance use services.

In addition, the standards also call for different measures to ensure accountability. The rule calls on states to use an independent entity to conduct “annual secret shopper surveys” to ensure managed care plans are complying with wait time standards and other aspects of the regulations.

From his perspective, Jessee says that CMS is aiming to reduce barriers to care for Medicaid and CHIP beneficiaries.

“I would say that it is certainly designed to ensure that states are tightening their processes around ensuring access,” Jessee says.

But as Jessee notes, access is only as good as the availability of certain providers in a given area.

“I think at the end of the day, if you're delivering services in a rural area, you're delivering services in areas that might be socially isolated, then your access is only as good as what providers exist. So it doesn't solve that issue,” Jessee says of the rule.

Some states have taken steps to ensure Medicaid recipients have better access to care. But Jessee says the federal government is aiming to see that the robust strategies implemented in some states are seen nationwide.

CMS is aiming to see that all states who utilize managed care as a service delivery “have at its core, standard measures and a standard set of criteria in terms of what good access looks like,” Jessee says.

And he says there are provisions that are designed at improving the quality of care. He notes some provisions are designed to ensure high-quality care is delivered more broadly, and that the measures and quality of care look similar.

“It really sets some consistency, almost like a national report card,” he says.

• Read more: From TV to CMS? Trump picks Dr. Oz to run Medicare and Medicaid

Jessee expresses hope that the rule could lead to better access, quality and transparency.

“These programs are the safety net. They're critically important to the people that we serve,” he says.