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Providers are one step closer to having to comply with the Medicaid Access Rule, a CMS proposal that includes the controversial stipulation that 80% of Medicaid reimbursement for home health, homemaker and personal care services must be spent on workers’ compensation. 

The provision, critics have noted, could create financial challenges — particularly for smaller providers — navigating an already tricky reimbursement landscape.

The Centers for Medicare & Medicaid Services sent its Ensuring Access to Medicaid Services proposed rule to the Office of Management and Budget on Friday.

“Rules with controversial provisions such as this one tend to sit at OMB for a while before they are released,” Damon Terzaghi, director of Medicaid advocacy at the National Association for Home Care & Hospice, said in a statement to McKnight’s Home Care Daily Pulse.

In October, home health providers and other industry advocates testified against the 80/20 rule in a House Energy and Commerce Committee hearing. Many noted that, despite CMS’ good intentions of alleviating workforce challenges, mandating 80% of Medicaid reimbursement to be spent on worker wages could only make the situation worse.

Market experts have said the 80/20 rule, in addition to other regulatory actions on the horizon, would be an impediment to home care mergers and acquisitions.

The Medicaid Access Rule also includes provisions that would require states to enhance transparency for home- and community-based services waiting lists, establish new oversight measures for Medicaid HCBS programs, and create a grievance system within fee-for-service HCBS.

CMS has stated it plans to issue a final rule by April. However, the agency will have to accommodate OMB meeting requests with interested stakeholders, “which will slow things down a bit,” Terzaghi said. NAHC has requested a meeting to discuss its concerns, he noted.

Nonetheless, he said he still believes the final rule will most likely be released in April.