The Centers for Medicare and Medicaid Services (CMS) released information on July 12 for states to support state compliance efforts with the Medicaid Access Rule which was finalized on May 10. The companion document clarifies regulatory intent and includes specific information on limited portions of the rule. We anticipate additional guidance on other portions of the rule in coming months.

CMS specifically targeted these details to help states with requirements to document access to care and payment rates for services and only applicable to fee for service reporting. Many of the provisions within the rule don’t apply to members, such as the comparison analysis to Medicare rates- which only applies to primary care, behavioral health, and OB/GYN services. From this guidance, providers may find information included on states’ obligations for rate aggregation and transparency. There are multiple useful examples of how CMS believes data should be displayed on state websites, most notably the fields that are included in templates and how comparisons are displayed. The full companion guide can be viewed here.

In a June 26 posting to the Federal Register the Centers for Medicare and Medicaid Services (CMS) announced non-substantive updates to the Medicaid Access Rule. In review of the posting of changes, LeadingAge agrees that most changes are insignificant corrections of citation cross references. The update includes clarification of some timelines for state compliance on participation in stakeholder groups that initially had compliance dates of the effective date of the rule (July 9, 2024). These dates and participant percentage thresholds have been updated to reflect compliance dates shifting to 2025 and beyond. Additional changes include clarification of federal obligations to update measures used in the home and community-based quality measure set which states are required to adopt through this rulemaking by December 31, 2026. The update can be accessed here.

On April 22, the Centers for Medicare and Medicaid Services (CMS) released the Medicaid Program: Ensuring Access to Medicaid Services final rule for public inspection. The rule is often referred to as the Medicaid Access Rule or the 80/20 rule. The rule will post to the federal register on May 10, with an effective date 60 days following, or July 9. The rule imposes significant requirements on states aimed at improving access to services and quality of those services. Beyond the state-level compliance requirements, this rule will give states four years to develop reporting structures and standards for some home and community-based services providers in the Medicaid program. At present, these providers are homemaker, home health, personal care, and habilitation.

Additionally, providers of homemaker, home health, and personal care services will need to demonstrate, in six years through this reporting, that 80% of their Medicaid rate is passed on to direct care staff. In addition to these, states will now need to adopt standard quality measures for home- and community-based services, make changes to critical incident management programs and reporting, impose more stringent minimum participation of beneficiaries on advisory groups, and publicly post substantial reporting and transparency on waitlists, access to services, rate setting and payment, among others.

Read the full article here.

Centers for Medicare & Medicaid Services (CMS) has posted two notices of proposed rule-making with aligned objectives. Some of the proposals’ comparable highlights: establishment of reporting requirements at both state and provider levels to demonstrate home and community based services (HCBS) rate allocation between direct service and administrative costs; transparency and reporting requirements on states to analyze and disclose provider-level payment rates while comparing some rates to Medicare’s rate for the same service; and establishment of advisory groups to increase stakeholder engagement.

Initial takeaways from the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Access, Finance, and Quality include developing maximum timeframes for participant access of standard primary care services and creating a single website where enrollees can review and select managed care plans based on networks and quality.

Initial takeaways from the Ensuring Access to Medicaid Services include imposing new requirements on states to improve access and quality of care for HCBS and promoting inquiry about health and quality of life outcomes.