CMS Final Rule: Ensuring Access to Medicaid Services

By Ken Bence posted 19 days ago


As I posted in the Open Forum last week, CMS has released a number of final rules that impact many aspects of the Medicaid program, including Home and Community-Based Services (HCBS). One of the rules we had been anxiously awaiting was the Access Rule.

When the proposed rule was released last year for public comment, it included a minimum 80% threshold of total reimbursement to be applied to direct care staff compensation in three categories of service: homemaker, home health aide, and personal care services. CMS also requested feedback and comment on whether such a threshold should also apply to habilitative services. ARRM, as well as many other providers and associations, submitted comments urging CMS not to impose the payment thresholds on any services, but certainly not habilitative services, because we believe they would have the opposite effect of the intent, and would actually decrease direct care worker wages and access to services for those who rely on them.

The text of the final rule was released last week, and it will be officially published in the Federal Register on May 10. While it does impose the 80% threshold on the three services listed above, habilitative services are not included. This is good news for most of our member organizations, although those that provide any of the three services will have to determine the total reimbursement they receive for any of the three services and calculate the total compensation paid to direct support workers when this provision goes into effect in six years. Both ‘direct care worker’ and ‘total compensation’ are defined broadly.

Another aspect of the Access Rule will require states to report compensation data to CMS within four years for a larger list of healthcare services, including the three listed above and habilitation. States will have a number of other reporting requirements, such as publishing all fee-for-service rates by July 1, 2026.

This is a very extensive rule (over 1,000 pages!) and we will continue to learn more about it from our national association, ANCOR, as they continue to analyze it and seek clarification where needed. You can find the full rule here and the CMS fact sheet here.

-Ken Bence, Director of Research, Analysis and Policy