The Centers for Medicare and Medicaid Services (CMS) published proposed rules on May 6 to require states to perform data analyses to consider if Medicaid payment rates are sufficient to enlist enough providers to ensure that health care is available to Medicaid recipients.   The proposed rules include methods that are also used in Medicaid upper payment limit (UPL) analyses, such as comparing Medicaid payment rates to Medicare payment rates, commercial insurance payment rates, providers’ usual and customary charges, and providers’ allowable costs.   The proposed rules would require stratification of such data by categories of provider ownership and control, also used in UPL analyses, with which PCG has extensive project experience.   CMS proposes a 5 year cycle for completing analyses across all provider classes in each state but would require the completion of some analyses annually and completion of relevant analyses within 12 months of submitting any state plan amendment that would reduce Medicaid payment rates in any state.  CMS also proposes methods of obtaining feedback from recipients and other stakeholders.   CMS is now discussing the proposed rules with all states.   The proposed rules are not based on new law but take into account several conflicting federal court rulings over the last 15 years and the recommendations of the Medicaid and CHIP Payment and Access Commission (MACPAC) created in 2009.  Comments on the proposed rules are due July 5.