Female healthcare worker assisting senior man in shaving at bathroom

The Centers for Medicare & Medicaid Services late Thursday proposed two rules surrounding access to Medicaid. Among the provisions are a requirement that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers.

The two proposed rules are Ensuring Access to Medicaid Services (Access NPRM); and Managed Care Access, Finance, and Quality (Managed Care NPRM). The former, Access NPRM, also would call for the following related to home care and home- and community-based services:

  • Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide and homemaker services;
  • Require states to establish an advisory group for interested parties to advise and consult on provider payment rates and direct compensation for direct care workers;
  • Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures;
  • Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures;
  • Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
  • Strengthen person‑centered service planning and incident management systems in HCBS; and
  • Require states to establish grievance systems in fee-for-service HCBS programs.

“The Biden-Harris Administration has made clear where we stand: We believe all Americans deserve the peace of mind that having health care coverage brings,” Department of Health and Human Services Secretary Xavier Becerra said in a statement. “We are proposing important actions to remove barriers to care, engage consumers, and improve access to services for all children and families enrolled in these critical programs.”

Providers expressed a lukewarm reaction to the rule. While they were pleased that the Biden administration is addressing access challenges and rate transparency with HCBS, they did not appreciate that the rule does not confront actual payment rates.

“Today’s announcement from CMS represents a mixed bag for the Medicaid program,” Damon Terzaghi, Medicaid director for the National Association for Home Care & Hospice, said in a statement released after the release of the rule. “We are heartened and excited to see that CMS is addressing issues related to waiting lists for home- and community-based services and delays in access to care, increasing transparency around provider payment rates and managed care contracting practices, and requiring states to provide more justification around their payment rate structures. All of these changes will help Medicaid beneficiaries and will help promote better access to community-based services.

“However, we are concerned that CMS is not proactively addressing the chronically woeful state payment rates for home and community-based services and instead is creating a new bureaucratic analysis that may or may not ever impact the wages of workers. We are further concerned that CMS has decided to forego ensuring adequate state payments in favor of applying an arbitrary requirement to pass through a proportion of the rates to direct care workers. This policy cannot be effective without consideration of the actual payment rates or the substantial administrative requirements that federal and state regulations place on providers.”

LeadingAge also did not wholly embrace the proposed rule. While it appreciated the emphasis on transparency on payment rates and input from stakeholders, it believes there needs to be more of a focus on the aging sector’s workforce needs, Mollie Gurian, vice president, home based and HCBS Policy, LeadingAge, said in a statement.

“We look forward to working with CMS to achieve transparency without placing unfunded administrative burden on our members and will continue the push for a smart leveraging of resources from across the federal government to increase the number of qualified staff in aging services,” she said. “Without staff, there is no care.”

See more McKnight’s coverage of the proposed rule.

This is a developing story. Please check back for updates.