The Countdown Has Started: Implementing the Medicaid Access Rule

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Ensuring Access to Medicaid Services final rule (Access Rule). The Access Rule has a particular focus on improving the access, quality, and transparency of home and community-based services (HCBS) programs. It also contains several provisions to ensure that Medicaid policy making is informed by engagement with beneficiaries and other stakeholders.Over the last few months, Aurrera Health has recapped the Access Rule in a series of blog posts:

• HCBS Requirements in the CMS Access Rule: What’s Next for Implementation?

• Advisory Committee Requirements in the Access Rule: What’s Next for Implementation?

• Strengthening Quality Measurement in Medicaid and CHIP Through the Access and Managed Care Rules

• Medicaid Managed Care: What’s Next for State and Managed Care Implementation?

The Access Rule’s effective date was July 9, 2024, at which time new state plan amendment procedures for HCBS rate reduction and restructuring began. Implementation deadlines for the various provisions of the rule will occur on a rolling basis, extending until 2030 for the HCBS payment adequacy requirement. While the deadlines are staggered, achieving them will require overlapping implementation timelines for states. To support state and stakeholder planning, Aurrera Health has developed an implementation timeline.

Implementation of each initiative under the rule will require tailored and wide-ranging work, from process and systems design for reporting requirements to larger policy changes for compliance thresholds. In addition, the rule’s emphasis on transparency, along with the need to ready stakeholders for their new responsibilities, will require robust stakeholder engagement every step of the way.In June, Aurrera Health Vice President Lauren Block and Managing Principal Kristal Vardaman, attended a Federal Policy Symposium held by the National Association of State Directors of Developmental Disability Services (NASDDDS). NASDDDS members, state administrators of services for people with disabilities, and other stakeholders who will play roles in implementing the Access Rule attended the conference. Lauren and Kristal moderated a panel on state efforts to implement the HCBS payment adequacy requirements, joined by representatives from Colorado and Washington State. By 2030, States must ensure that 80 percent of certain HCBS payments to providers go toward compensating direct care workers that perform these services. Both Colorado and Washington State have long histories of engaging in efforts to expand HCBS workforce capacity, including policies supporting increased worker compensation. However, as representatives from both states shared, despite their extensive investments, they have significant work to do to comply with this provision. States that have not been as proactive on HCBS workforce policy may find implementing the HCBS payment adequacy provision is an even bigger effort than these pioneers and may consider pursuing policy changes that take time to achieve their intended results. Although six years may seem like a long way away, implementation of the HCBS Settings Rule, with similarly complex requirements, took ten years to be fully implemented after several delays. States may need the full six years to realize policy changes necessary to achieve compliance. The clock is ticking!

Aurrera Health Blog Series on Access and Managed Care Final Rules

Implementing the Access and Managed Care Rules require a significant investment in state time and resources. Aurrera Health looks forward to helping states and other stakeholders understand and implement requirements to support Medicaid beneficiary access. If you would like to discuss how we can help your state, please reach out to Aurrera Health Managing Principal Kristal Vardaman.

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Authors

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Kristal Vardaman [Managing Principal]