As you may be aware, the Centers for Medicare and Medicaid Services (CMS) issued a notice of proposed rulemaking early last month that broadly seeks to improve access to care and better address health equity issues in the Medicaid program. Entitled Ensuring Access to Medicaid Services, many provisions of the proposed rule apply to home and community-based services. ANCOR, our national association, has been taking the lead on evaluating the proposed rule, communicating its content to member organizations, gathering feedback, and developing resources to facilitate the submission of comments during the public comment period, which closes on July 3.
ANCOR’s analysis highlighted the following provisions, which would:
- Require states to assure that at least 80% of all Medicaid payments for homemaker services, home health aide services, and personal care services are spent on compensation to direct care workers.
- Require states to publish their fee-for-service Medicaid payment rates in a clearly accessible location and report the date when payment rates were last updated.
- Require states to report annually to CMS on metrics related to waiting lists, including the number of people waiting, average wait times, and methodologies for determining eligibility.
- Require states to use the HCBS Quality Measure Set in 1915(c) waiver programs.
- Define critical incidents and require states to operate and maintain an incident management system, including a requirement that providers report critical incidents.
While most of these requirements are viewed favorably from a provider perspective, and have proposed implementation timelines of 2-4 years or more, they would likely impose significant burden on the states. The 80% payment adequacy provision, however, is quite concerning. While at this stage, it does not appear to apply to habilitative services, it does not get to the root cause of the direct support workforce crisis: stagnant and insufficient Medicaid payment rates that do not include adequate funding for competitive wages. Also, it is not driven by data or proven to be an effective practice, and CMS has failed to describe how establishing such a threshold would not further constrain providers’ already limited resources.
Using ANCOR’s template as a starting point, ARRM has drafted its comment letter, which is scheduled to be submitted to CMS on Friday, June 30. I invite you to review it, consider submitting a letter of your own (because, remember, there is power in numbers when it comes to public comments), and contact me if you feel we have missed the opportunity to comment on a particular provision. To submit your own letter, go to this website and click "Submit a Formal Comment."
-Ken Bence, Director of Research, Analysis and Policy