The Centers for Medicare & Medicaid Services (CMS) published a proposed rule, Ensuring Access to Medicaid Services (Access Rule), to improve access to, and quality of, Medicaid services.

What is most important for people with disabilities to know?

The Rule is long and complex but here’s what’s most important to know. (Credit: Access Rule Toolkit from Autism Society and NACDD)

Under the proposed Access Rule:

Growing the Direct Care Workforce and Transparency in Payment Rates

• At least 80 percent of all Medicaid payments for specific HCBS — homemaker services, home health aide services, and personal care services — must be spent on compensation for direct care workers to help address the direct care workforce crisis.
• Require states to publish average hourly payment rates for certain providers of HCBS every two years.
• Require states to establish an advisory group to advise and consult on fee-for-service rates paid for personal care, home health aide, and homemaker services.

Better Oversight and Monitoring HCBS Waitlists

• States must report information on their section 1915(c) HCBS waiver waitlists, including the length of the waitlists.
• States must also report whether people can access services across HCBS authorities once the services are approved.
• This data allows a comparison of HCBS accessibility in different states.

Strengthen Person-Centered Service Planning and Incident Management Systems

• States must demonstrate that as part of person-centered planning, a reassessment of need is completed at least once a year for people continuously enrolled in HCBS programs. They also must demonstrate that service plans are reviewed and revised annually based on that reassessment.
• States must operate and maintain an electronic incident management system and investigate, address, and report on the outcomes of the incidents within specified timeframes.
• States must establish and manage a grievance process for people receiving HCBS in fee-for-service plans. (This already exists in Medicaid-managed care.) This system will give people a way to notify their state Medicaid agency if they have a complaint about how a provider or state is complying with Medicaid requirements.

Establish New Oversight, Monitoring, Quality Assurance, and Quality Improvement for HCBS Programs

• States must report on a set of nationally standardized quality measures specifically for HCBS established by CMS.

SARTAC also published a plain language explanation of the Access Rule.

What you can do:

This rule impacts people with disabilities and their families.

If this is important to you, you can submit a comment about this rule.

The Autism Society has set up an easy link on their page to submit a public comment.

Click here to leave a public comment.

Public Comments are due by Monday, July 3rd.