On May 3, 2023 the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The proposed rule seeks to increase transparency in payment rates, standardize data and monitoring and create new opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care. The rule also has a particular focus on home and community-based services (HCBS), including direct care worker compensation requirements, grievance process development, critical incident reporting definitions and HCBS quality reporting.
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Key Takeaways
The Medicaid; Ensuring Access to Medicaid Services proposed rule includes the following key proposals:
- Rescinding access monitoring review process (AMRP) requirements and instead requiring states to make all fee-for-service (FFS) Medicaid payment rates public and accessible on a state website
- Requiring states to conduct a comparative payment rate analysis between the state’s Medicaid payment rates and Medicare rates for certain services
- Strengthening states use Medical Care Advisory Committees and creating a new Beneficiary Advisory Group
- Requiring that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit)
- Requiring reporting on waiting lists in section 1915(c) waiver programs and service delivery timeliness for personal care, homemaker and home health aide services
- Enhancing HCBS quality reporting and timeliness.
