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Developmental Disabilities Administration
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April 30, 2024
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Sharing Information from ACL: The Medicaid Access Rule: A Historic Regulation to Strengthen Home and Community-Based Services
The Administration for Community Living has provided information on the Centers for Medicare & Medicaid Services final rule: Ensuring Access to Medicaid Services. The information includes new requirements related to the direct care workforce, access to home and community-based services, health and safety protections, quality measures and more.
The Access Rule is the most consequential, comprehensive regulation related to Medicaid-funded HCBS in a decade. It will strengthen the HCBS that make it possible for people to live in their own homes, stay connected to friends and family and participate in the community in ways that are meaningful to them.
DDA is putting together a project plan and doing a self-assessment to determine gaps. Stay tuned for more information.
Please check out the ACL Blog link below for more information on:
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Payment adequacy: At least 80% of all Medicaid payments for specific HCBS — homemaker services, home health aide services and personal care services — must be spent on compensation for direct care workers to help address the direct care workforce crisis. States must also report annually on the percentage of payments for those three services (homemaker, home health aide and personal care), as well as habilitation services, that are spent on compensation for direct care workers. States must also establish an interested parties advisory group to seek input on payment rates for these four services.
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Access: States must report information on HCBS waiting lists. They also must report on whether people have timely and full access to homemaker, home health aide, personal care, and habilitation services once services are approved. This data allows a comparison of access to HCBS across states.
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Person-centered planning: States must demonstrate that, as part of person-centered planning, a reassessment of need is completed at least once a year for people continuously enrolled in HCBS programs. They also must demonstrate that service plans are reviewed and revised annually based on that reassessment.
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Incident management: States must operate and maintain an electronic incident management system using a common minimum definition for what is considered a “critical incident.” They must also investigate, address and report on the outcomes of the incidents within specified timeframes.
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Grievances: States must establish and manage a grievance process for people receiving HCBS in fee-for-service systems. (This already exists in Medicaid managed care systems.) This process will give people a way to notify their state Medicaid agency if they have a complaint about how a provider or state is complying with person-centered planning and HCBS Settings Rule requirements.
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Quality measures: States must report on a set of nationally standardized quality measures specifically for HCBS established by CMS through a process that includes opportunities for public comment.
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