Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure will appear before a US Senate panel in 2021. (Rod Lamkey/CNP/Zuma Press/TNS)
Federal Medicaid officials are proposing major changes aimed at improving access to home-based and community-based services for people with disabilities and strengthening the workforce of direct assistance professionals. increase.
The Centers for Medicare and Medicaid Services released two proposed rules in the Federal Register this week. The agency says it “establishes historic national standards for access to care, whether care is provided through a managed care plan or directly by the state for a fee.” -service. “
This effort includes the so-called Secure access to Medicaid services rule, or access rule.
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Under this proposal, states would be required to annually reassess the needs of each individual receiving household and community-based services and revise service plans accordingly. In addition, the rule requires that at least 80% of what Medicaid pays for personal care, housewife, and home health care assistance services goes directly to compensate those who provide the services, not for administrative purposes or profit. . States should also publish the average hourly wages paid to direct care workers.
The 130-page regulation also includes new mandates for states to report on waiting list lengths, whether people can access services after waivers, and various quality measures in home and community-based service programs. CMS expects states to maintain electronic incident management systems and respond to incidents within specified time frames. States should also create a grievance process for recipients of traditional Medicaid plan home-based and community-based services. This allows you to file a complaint with the provider or the state in the same way that it already exists for those covered by managed care plans.
Once finalized, the access rules “superceed and fully replace the reporting and performance expectations set forth in the March 2014 guidance on the Section 1915(c) exemption program,” CMS said.
The proposed changes come as home and community-based service providers across the country struggle to retain and survive direct support staff. and more than 80% reported refusing service to people with disabilities.
In addition to access rules, the CMS Access to managed care, finance and quality proposed rule. The regulation surveys managed care registrants regularly about their experience, establishes maximum appointment wait time standards, and ensures that managed care plans comply with appointment wait time standards; Requires states to conduct confidential shopper surveys annually to ensure that their directory and providers are accurate. and other changes.
“Healthcare coverage is fundamental to reducing health disparities, but it must go hand in hand with timely access to services. It’s at the heart of our rules,” said Chiquita Brooks-LaSure, CMS administrator. “With the provisions we have outlined, we are poised to bring Medicaid or[children’s health insurance programs]coverage and access together in an unprecedented way. It is a long-awaited and important priority for some program participants.”
Both proposed rules are open for public comment until July 3rd.
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