Home care had quite a week in Washington, DC. Providers who fanned across the Capitol for their annual advocacy days likely had much to talk about as lawmakers introduced long-term care workforce legislation and a Senate Special Committee on Aging held a hearing on the frontline workforce.

Perhaps overshadowing the legislative developments were providers’ expectations regarding two major rules on the verge of release, which could potentially reshape the landscape of home care. One of these is the Medicaid Access Rule, which is expected to feature the controversial 80/20 provision. The latter would require that 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for direct care workers. Home care providers universally have been critical of this rule as it would place an undue financial burden on providers that need to use the 80% for training, career advancement, supervision, oversight and recognition programs, and other agency activities.

“The negative impacts to patient access nationally will be swift and severe,” Jason Lee, CEO of the Home Care Association of America, said earlier this month in response to an address by the president about the care economy. “Most providers will curtail services, while many will leave the Medicaid space entirely. 80/20 will only serve to reduce access, particularly in rural and underserved communities, contradicting the purported goal of the proposed rule.”

He noted that the rule, if finalized in its current form, will hurt agencies abilities’ to recruit and retain caregivers. A better solution is to encourage states to increase the reimbursement rates and offer an enhanced Federal Medical Assistance Percentage (FMAP) to raise direct care worker wages.

“Restricting costs and prescribing rates at an arbitrary 80/20 ratio would contradict many of the quality measure efforts that we actively support in the proposed rule,” he said. “This is a time when the industry needs more support and more innovation, not less funding and more regulation.”

Yet another pending rule — the nursing home staffing mandate — also could have an impact on home care. New expensive staffing requirements could drive nursing homes to limit admissions or close, forcing patients to seek out home care.

With both rules pending, the spring season, at least as far as home care is concerned, is off to a sizzling start.

Liza Berger is editor of McKnight’s Home Care. Email her at [email protected].