The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule to advance CMS' efforts to improve access to care, quality, and health outcomes for Medicaid recipients, including those receiving home- and community-based services (HCBS). The proposed rule, Medicaid Program: Ensuring Access to Medicaid Services, was published in the Federal Register on May 3, 2023.

Among other provisions of the Social Security Act, there is an "equal access provision" that requires Medicaid provider payments to be "consistent with the efficiency, economy, and quality of care...sufficient enough to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in a geographic area."

This statutory provision was not regulated for decades until 2015 when the Obama administration finalized regulations requiring states to report certain Medicaid services and payment structures. The 2015 regulations did not cover HCBS, but this proposed rule does.

The proposed rule includes positive policy developments, including new state reporting requirements that enhance transparency and stakeholder input on Medicaid reimbursement rates. CMS also aims to establish an incident management system and grievance process for HCBS, as well as require states to report on waiting lists for services.

While these provisions align with the equal access provision and represent positive steps, HCAF has concerns regarding a specific proposal that requires a minimum of 80% of Medicaid payments, including base and supplemental payments, be allocated for compensating direct care workers who provide homemaker, home health, and personal care services. This compensation includes wages, overtime pay, payroll taxes, and certain benefits, while other expenses would be covered by the remaining 20% of the payment. The requirement would take effect four years after the effective date.

Direct care workers are instrumental in delivering essential care to Medicaid recipients, enabling aging individuals to maintain independence and dignity in their own homes. Unfortunately, these workers are severely underpaid due to outdated and inadequate Medicaid reimbursement rates, as evidenced by the high 77% turnover rate in 2022. Regrettably, the proposed rule's approach of a "one-size-fits-all" solution to address Medicaid program challenges fails to acknowledge the significant negative impact it could have on both providers and patients. Implementing the rule as proposed may increase hospitalizations and institutionalizations among Medicaid recipients, leading to greater costs for Medicaid and increased burden on American taxpayers.

CMS is accepting comments from stakeholders until July 3, 2023. HCAF will submit comments on behalf of the Florida Medicaid provider community, but we strongly encourage all Medicaid providers to participate and make their voices heard. If you wish to submit comments, please do so electronically at Regulations.gov, by mail, or using the form below. In commenting, please refer to file code "CMS-2442-P".

Submit via regular mail to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-2442-P
P.O. Box 8016
Baltimore, MD 21244-1850

Submit via express or overnight mail to:

Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-2442-P
Mail Stop C4-26-05
7500 Security Boulevard
Baltimore, MD 21244-1850

During the preparation of comments, providers should consider the following variables to demonstrate the proposal's impact on their agency and their ability to continue serving Medicaid recipients. A customizable template is also available below.

For more information, please contact Kyle Simon, Director of Government Affairs and Communications, at (850) 222-8967 or ksimon@homecarefla.org.