The Centers for Medicare & Medicaid Services (CMS) is currently in the process of finalizing the 2024 final rule for ensuring access to home and community-based (HCBS) services. Originally proposed last Spring, the Ensuring Access to Medicaid Services proposed rule would, among other items, require HCBS providers to allocate 80% of HCBS payments to direct care worker pay and establish mandatory quality measures for HCBS services.
To improve access to and quality of Medicaid HCBS, the proposed rule would:
- Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
- Promote public transparency related to the administration of Medicaid covered HCBS through public reporting of quality, performance, and compliance measures.
- Require that at least 80% of Medicaid payments for personal care, homemaker and home health aide services be spent on compensation for the direct care;
- Strengthen person centered service planning and incident management systems in HCBS;
- Require states to establish grievance systems in FFS HCBS programs;
- Require states to publish the average hourly rate paid to direct care workers delivering personal care, home health aide, and homemaker services;
- Require states to establish an advisory group for interested parties to advise and consult on provider rates for direct care workers; and
- Require states to report on waiting lists in section 1915(c) waiver programs; service delivery timeliness for personal care, homemaker and home health aide services; and a standardized set of HCBS quality measures.
The proposed rule was sent to the White House Office of Management and Budget last week and CMS plans to issue the final rule by April.