In April 2023, the Centers for Medicare & Medicaid Services (CMS) proposed two new rules impacting home- and community-based services (HCBS) for people with disabilities. The rules were entered in the Federal Register, along with the agency’s stated aim to “establish historic national standards for access to care regardless of whether that care is provided through managed care plans or directly by states through fee-for-service.” Here, we summarize the changes included with each rule, how HCBS providers are responding, and potential next steps.
Access To Care
The first rule has been named the Ensuring Access to Medicaid Services regulation, or the Access Rule. This provision is designed to improve access to care for people with disabilities and includes several key changes. The revised changes requires states to:
- Annually reassess care needs for all individuals receiving HCBS and update their care plans.
- Ensure that 80% of Medicaid payment for services “goes directly toward compensation for the person providing the service rather than for administrative purposes or profit.” This would apply to home health aide, homemaker, and personal care services.
- “Publish the average hourly rate paid to direct care workers.”
- Share waiting list numbers, HCBS waivers, and quality measures.
- “Maintain an electronic incident management system” and establish a reporting process for grievances.
Quality of Care
The second rule has been named the Managed Care Access, Finance and Quality proposed rule. This provision is intended to improve quality and reduce disparities among recipients and includes several key changes. The revised changes requires states to:
- Conduct surveys with HCBS enrollees.
- Establish “maximum appointment wait time standards.”
- Annually “conduct secret shopper surveys” to ensure compliance among managed care plans. These surveys are designed to determine whether appointment wait times are being honored and that provider directories are up-to-date.
Public Comment
All Medicaid proposed rule changes are followed by a 60-day public comment period. In this case, the comment period expires on July 3, 2023. As of June 1, only 45 comments had been received; however, three home-care groups and five associations have requested an extension of “at least 30 days” to the public comment period.
The three home-care groups requesting more time are:
- Home Care Association of America (HCAOA);
- National Association for Home Care & Hospice (NAHC); and
- Partnership for Medicaid Home-Based Care (PMHC).
In their joint letter, they noted: “It will take our organizations immense time and effort to collect the data to inform CMS’s final decisions in a comprehensive, thoughtful manner.”
In addition, the executive directors of the following five associations also sent a letter requesting more time for review:
- ADvancing States;
- National Association of Medicaid Directors;
- National Association of State Head Injury Administrators;
- National Association of State Mental Health Program Directors; and
- National Association of State Directors of Developmental Disabilities Services.
As with the home-care groups, these associations cited: “The scope and complexity of CMS’s policy ideas would require significant time to analyze and respond to in normal times. We do not find ourselves in normal times.”
Next Steps
Providers are currently working with states to assess needs as the public health emergency (PHE) officially comes to an end. Nationwide, many are still dealing with the aftermath of the pandemic, with 60% reporting they had to discontinue programs in 2022 and 80% reporting they had “denied services to people with disabilities.”
This, combined with an ongoing workforce shortage and advocacy efforts to address “longstanding, chronic underfunding,” have left providers feeling concerned about the financial impact of new requirements.
To date, no extension has been announced by CMS.
Sources: https://www.disabilityscoop.com/2023/05/05/feds-want-to-shake-up-rules-for-home-and-community-based-services/30371/
https://homehealthcarenews.com/2023/06/home-care-groups-industry-needs-more-time-to-review-one-of-the-most-impactful-proposed-rules-in-medicaid-hcbs-history/
https://www.mcknightsseniorliving.com/home/news/cms-proposed-hcbs-rules-elicit-request-for-extension-of-comment-period-from-5-associations/