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CMS Finalizes Medicaid Access Rule with 80/20 Wage Pass-Through

The Centers for Medicare and Medicaid Services (CMS) has finalized the Ensuring Access to Medicaid Services rule with significant updates from the proposed rule. The rule broadly updates transparency and stakeholder engagement in state Medicaid programs, for both managed care and fee-for-service, with the goal of increasing access to and quality of services delivered in Medicaid. It imposes requirements on states to ensure that providers are passing a minimum of 80 percent of Medicaid funds for homemaker, home health, and personal assistance services on to workers.

CMS has updated some of the definitions to include clinical supervision as an included cost related to direct care and has also outlined their intent to include workers' compensation in the 80 percent threshold.

While the rule includes many positive developments such as the ability of states to establish both separate small provider minimum standards and hardship exemptions, it overall maintains provisions that could impose significant challenges on providers.

These provisions are on a six-year implementation runway. The rule has substantial updates, so additional analysis will be necessary.

LeadingAge NY will be working with LeadingAge National to understand how the rule will impact home and community-based services (HCBS) providers and plans. A more substantial analysis will be provided after further review. The CMS Fact Sheet is available here, and the rule is here.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871