What: In April, the Centers for Medicare & Medicaid Services (CMS) released the final Medicaid Access Rule. As you know from our recent update, many of our shared concerns across the network were not addressed in the final rule, including new requirements related to payment of the direct care workforce. Specifically at least 80% of all Medicaid payments must be spent on compensation for direct care workers and/or states must report annually on percent of payments that go to the direct care workforce. Other provisions also include changes in access to home- and community-based services (HCBS), health and safety protections, and quality measures. Given the scope and impact on our work and services, our work continues and also moves to the state level.
What Happens Now? Because the Access Rule requires states to make significant changes to their Medicaid programs, CMS is allowing states several years to implement the provisions. This is a time to consider strengthening your discussions with state-level decisionmakers to inform the implementation of the provisions.
Under the rule, states are required to create home care and rate-setting advisory boards made up of Medicaid beneficiaries, home care workers and others to advise states on provider payment rates and worker compensation. Thus, its important to be in conversation with state-level officials to inform the make-up and considerations of these boards. We will continue conversations with CMS as we learn more about guidance, timing and other considerations.
How to prepare: Given the rationale for the rule change is to improve job quality and pay for direct care workers to attract more people to those jobs, it will be important to articulate the impact to your organization, including how this makes it harder to deliver quality services. The rule will also require states to be more transparent in how they pay for home- and community-based services, as well as how they set rates.
The following are the key components of the rule to be aware of:
- at least 80% of all Medicaid payments must be spent on compensation for direct care workers and/or states must report annually on percent of payments that go to the direct care workforce,
- states must report information on HCBS wait lists (specifically timely and full access to services),
- prioritization of person-centered planning,
- states must demonstrate an electronic incident management system,
- states must establish and manage a grievance process and
- states must report on a set of nationally standardize quality measures.
For more information, please contact Bill Kallestad.
Bill Kallestad is the Director of Public Policy and Advocacy for the Lutheran Services in America Disability Network.
