LeadingAge National QuickCast on Medicaid Access Rule Now Available

(June 4, 2024) 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 Medicaid Access Rule, also called the 80/20 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 its intent to include workers' compensation in the 80 percent threshold.

Members should note that this requirement does not pertain to those services if they are provided in bundled rates, such as those associated with Assisted Living Programs (ALPs), adult day health care (ADHC), and social adult day care (SADC).

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. States are required to establish reporting structures by 2028, and the payment threshold requirements take effect in 2030. The rule has substantial updates, so additional analysis will be necessary.

LeadingAge National has provided a detailed article on the requirement here. The CMS Fact Sheet is available here, and the rule is here.

A LeadingAge National QuickCast on the rule is here.

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