Feds Finalize New Rules For Medicaid Home And Community-Based Services

A direct support worker, center, puts on Keith Conley’s shoes, as his brother Kristopher moves around their home in Reynoldsburg, Ohio. The twin brothers have severe autism, need 24-hour care, and have had a lot of trouble finding quality, reliable aides to help them. (Courtney Hergesheimer/The Columbus Dispatch/TNS)

Federal officials are reshaping the rules surrounding Medicaid home and community-based services for people with disabilities in an effort to improve access and strengthen the professional direct support workforce.

Under final rule Released this week, the Centers for Medicare and Medicaid Services is establishing minimum payment thresholds for direct care providers, requiring states to periodically reassess the needs of those receiving home and community-based services, and much more.

The regulation known as the “Ensuring Access to Medicaid Services,” or Access Rule, comes in response to the growing shift toward people with disabilities living in the community rather than in institutions.

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With the rule, CMS said it sought to address significant variations among states in terms of quality and reporting requirements, while also addressing the national shortage of direct care workers.

“The Access Rule is the most significant and comprehensive regulation related to Medicaid-funded HCBS in a decade,” said Alison Barkoff, who serves as administrator at the U.S. Department of Health and Human Services’ Community Living Administration. “It will strengthen the HCBS that make it possible for people to live in their own homes, stay connected with friends and family, and participate in the community in ways that are meaningful to them.”

The regulation clarifies that states must annually reevaluate the needs of each person receiving home and community-based services and revise their service plan accordingly. Additionally, states will have to maintain an electronic incident management system and respond to incidents within specific timeframes. They will also need to establish a grievance process so that beneficiaries of traditional Medicaid plans can file complaints against a provider or the state if they experience problems receiving the home and community-based services required in their plan, much like the process that already exists for those. with managed care plans.

Under the measure, at least 80% of Medicaid payments for homemaker, home health aide and personal care services must go toward direct care workers’ compensation rather than administrative expenses, with limited exceptions . States will have to disclose the average hourly rate paid to workers for these services. Additionally, states will face new requirements to report on a standardized set of quality measures, as well as how they establish and maintain their waiting lists and the timeliness of service delivery.

Jennifer Lav, senior staff attorney at the National Health Law Program, said she is optimistic that the changes will improve the availability of services for people with disabilities.

“Nationally, there is a critical shortage of direct care workforce. Too often, people eligible for HCBS, which allows people with disabilities and complex medical needs to live in their homes and communities, cannot find anyone to provide them with these essential supports,” Lav said. “The HCBS Access Rule creates a mechanism to address historically underrated rates and provides for a fair share of state and federal Medicaid dollars to go directly toward the wages of direct care workers, a workforce that is largely made up of measured by immigrants and people of color. Ultimately, we hope this will increase access to critical HCBS services that allow people with disabilities to live in their own communities while improving historical inequities in how this workforce is paid.”

The new rule will take effect 60 days after its publication in the Federal Register, but states will have years to comply with many of the requirements.

In addition to the Access Rule, CMS is also finalizing regulations that institute minimum staffing standards for nursing homes and a rule that imposes new requirements for managed care plans.

States will be required to periodically survey Medicaid beneficiaries enrolled in managed care plans about their experiences and will be required to conduct “secret shopper” surveys annually to ensure that managed care plans provide accurate provider directories and meet timeline standards. waiting for appointments, among other things. rules.

“Everyone should have equal access to the critical care they need,” said Health and Human Services Secretary Xavier Becerra. “We are taking important steps to strengthen care provided through Medicaid and CHIP, and establishing national nursing home staffing standards to improve care for residents while improving conditions for workers. “This will help ensure that millions of people have access to high-quality healthcare and that the dedicated workers who provide care to our loved ones are fully valued for their work.”

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