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Apr 27 -- 1) Ensuring beneficiaries can access covered services is a critical function of the Medicaid program and a top priority of the Centers for Medicare & Medicaid Services (CMS). The proposed rule, Ensuring Access to Medicaid Services, outlined in this fact sheet, includes both proposed changes to current requirements and newly proposed requirements that would advance CMS’s efforts to improve access to care, quality, and health outcomes, and better promote health equity for Medicaid beneficiaries across fee-for-service (FFS) and managed care delivery systems, including for home and community-based services (HCBS) provided through those delivery systems. These proposed requirements are intended to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement in their Medicaid programs. Medicaid and CHIP are the nation’s largest health coverage programs. If adopted as proposed, these rules would build on Medicaid’s already strong foundation as an essential program for millions of families and individuals, especially children, pregnant people, older adults, and people with disabilities.

To advance the President’s long-term care priorities, President Biden’s Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers directs the Department of Health and Human Services (HHS) to consider issuing several regulations and guidance documents to improve the quality of home care jobs, including by leveraging Medicaid funding to ensure there are enough home care workers to provide care to seniors and people with disabilities enrolled in Medicaid.  Through this proposed rule, CMS is also fulfilling the directive for HHS to consider rulemaking to improve access to HCBS under Medicaid.

Public comments are requested on the Notice of Proposed Rulemaking (NPRM), including in response to specific questions articulated throughout the publication.

A substantive component of this proposed rule focuses on improving access to, and the quality of HCBS. Over the past several decades, HCBS have become a critical component of the Medicaid program and are part of a larger framework of progress toward community integration of older adults and people of all ages with disabilities that spans efforts across the Federal government. The proposed changes in this rule are intended to strengthen necessary safeguards to ensure health and welfare, promote health equity for people receiving Medicaid‑covered HCBS, and achieve a more consistent and coordinated approach to the administration of policies and procedures across Medicaid HCBS programs. Specifically, the proposed rule seeks to:

-- Establish a new strategy for oversight, monitoring, quality assurance, and quality improvement for HCBS programs;
-- Strengthen person‑centered service planning and incident management systems in HCBS;
-- Require states to establish grievance systems in FFS HCBS programs;
-- 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 workforce (as opposed to administrative overhead or profit);
-- 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 payment rates and direct compensation for direct care workers;
-- 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; and
-- Promote public transparency related to the administration of Medicaid‑covered HCBS through public reporting of quality, performance, and compliance measures. . . .
Fact sheet: https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking

2) Section 1902(a)(4) of the Act is a longstanding statutory provision that, as implemented in part in regulations currently codified at § 431.12, requires states to have a Medical Care Advisory Committee (MCAC) in place to advise the state Medicaid agency about health and medical care services. Recent research regarding soliciting input from individuals with lived experience, including discussions with states about their MCAC, provides CMS with a unique opportunity to re-examine the purpose of this committee and update the policies to reflect four decades of program experience. Based on these learnings, we know that these requirements need to be more robust to ensure all states are using these committees optimally to leverage the experiences of beneficiaries, their caretakers, and other stakeholders. The MCAC provisions of the proposed rule outline changes that will support the implementation of the principles of two-way feedback, transparency, and accountability.

The proposed rule would change the MCAC structure and operations to support more meaningful and accessible engagement by all Committee members with a particular emphasis on Medicaid beneficiaries. If finalized, these provisions will:

-- Rename and expand the scope and use of states’ Medical Care Advisory Committees. States would be required to establish and operate the newly named Medicaid Advisory Committee (MAC) and a Beneficiary Advisory Group (BAG). The MAC and its corresponding BAG would serve as vehicles for two-way communication between interested parties and the state on topics related to the effective administration of the Medicaid program. The proposals in the proposed rule seek to expand the topics to be addressed by the Committee beyond health and medical services to include policy development and effective program administration. The specific topics addressed by the MAC would be based on each state’s needs and determined in collaboration with the MAC members.
-- Establish minimum requirements for stakeholder representation on the MAC. The MAC would include representation from the BAG, and other interested parties, such as consumer advocacy groups, clinical providers or administrators, Medicaid managed care plans, and other state agencies serving Medicaid beneficiaries. States would select members in a way that reflects a wide range of their Medicaid stakeholders (i.e., covering a diverse set of populations and interests relevant to the Medicaid program), places a special emphasis on the inclusion of the Medicaid beneficiary perspective, and creates a meeting environment where each voice is empowered to participate equally.
-- Require states to establish a beneficiary-only group with crossover membership with the MAC. Under the proposal, States would be required to establish the BAG, a standalone group, that will meet separately from the MAC. The BAG would include Medicaid beneficiaries, their family members, and/or their caregivers. At least 25 percent of the MAC membership would be reserved for BAG members.
-- Promote transparency and accountability between the state and its stakeholders by making information on the MAC and BAG activities publicly available. In order to be responsive to the needs of its stakeholders, states need to be able to gather feedback from a variety of people that touch the Medicaid program. Under our proposal, the MAC and BAG will serve as the vehicle through which states can obtain this feedback. In turn, states will publicly share information about the feedback they receive. Specifically, states will post MAC and BAG membership lists, meeting schedules, meeting minutes, by-laws, recruitment processes, and an annual report on MAC activities on its website. The annual report will seek to both promote transparency and accountability at the state level by providing a public view into the impact of the MAC and BAG’s feedback.

Federal financial participation for MAC and BAG activities would remain available to states in the same manner as for the current MCAC.

Fact sheet: https://www.cms.gov/newsroom/fact-sheets/ensuring-access-medicaid-services-cms-2442-p-notice-proposed-rulemaking-0

3) May 3 -- FRN: This proposed rule takes a comprehensive approach to improving access to care, quality and health outcomes, and better addressing health equity issues in the Medicaid program across fee-for-service (FFS), managed care delivery systems, and in home and community-based services (HCBS) programs. These proposed improvements seek to increase transparency and accountability, standardize data and monitoring, and create opportunities for States to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care. To be assured consideration, comments must be received by July 3, 2023.

Proposed rule: https://www.federalregister.gov/d/2023-08959 [130 pages]

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