Woman reading to mother at table

The National Association for Home Care & Hospice is “concerned about the approach” the  Centers for Medicare & Medicaid Services is taking to expand Medicaid access in its proposed rule issued last month.

The proposed regulation — Ensuring Access to Medicaid Services (Access NPRM) — would require 80% of Medicaid payments for home health aide, homemaker and personal care services go toward compensation for direct care workers and require states to publish the average hourly rate paid to direct care workers, among other requirements . CMS also proposed another rule, Managed Care Access, Finance, and Quality, in conjunction with Access NPRM.

“We had hoped in earnest that the rule that was expected to come from the CMS would help in expanding access to care and stabilizing the program in times of a workforce shortage,” NAHC President Bill Dombi said during a webinar Wednesday. “Unfortunately the rule that’s been issued we believe may create more access problems than it solves.”

NAHC Medicaid Director Damon Terzaghi identified the limited scope of services Access NPRM encompasses. Although the rule stipulates that 80% of Medicaid payments go towards employee wages, this only applies to employees of homemaker, personal care and home health aide services.

“CMS specifically asked for feedback on whether they should include other services within this requirement in a final rule or in subsequent rulemaking,” he said.

He also added that the onus for making sure employees see the benefits of that requirement is on the states, not the providers themselves. 

“I really want to stress that it’s a state level assurance,” he said. “CMS is not actually putting anything specifically on providers.”

Terzaghi stressed that the proposed rule is not yet official,but said NAHC anticipates that CMS will try to finalize it.