CMS Holds Open Door Forum on Access Rule

Today, July 30, at 2 pm EDT, the Centers for Medicare and Medicaid Services (CMS) is hosting its Long-Term Services and Supports Listening Session. This session will focus on the payment adequacy provision of the CMS Access Rule. Participants are asked to pre-register using the registration link. 

CMS shared a draft agenda and sample questions, posted below: 

Opening Remarks 

• Moderator – Jill Darling (OC) 

• Alissa Deboy, Director of the Medicaid Benefits and Health Program Group (MBHPG), CMCS 

• Jennifer Bowdoin – Director of the Division of Community Systems Transformation, MBHPG 

Overview of Payment Adequacy Provisions of the Ensuring Access to Medicaid Services Final Rule  

Building on the information shared during the May 7, 2024 Long-Term Services and Support Open Door Forum, CMS will share a brief overview of the home and community-based services (HCBS) provisions in the Ensuring Access to Medicaid Services Final Rule including a deeper-dive on what is commonly referred to as the “HCBS payment adequacy provision.” This provision of the final rule requires that within six years, states generally ensure a minimum of 80% of Medicaid payments for homemaker, home health aide, and personal care services be spent on compensation for direct care workers furnishing these services, subject to certain flexibilities and exceptions. CMS will also provide an overview of related reporting requirements. 

After the overview, participants will have the opportunity to provide individual feedback on the questions below which will help inform implementation of this provision. 

Example Questions 

• What additional information or clarification do you need from CMS to be able to report on the percent of Medicaid payments spent on compensation? 

• What additional information or clarification do you need from CMS to be able to meet the minimum performance level? 

• How much time do you need after the end of each calendar year to be able to report on the percent of Medicaid payments spent on compensation? 

• Do you plan to report the data directly to states or would your organization use a third party to calculate and report the information to states? 

• What recommendations do you have for how states collect the data from providers? Are there existing information systems you would want states to use to collect the data? 

• States have flexibility to provide hardship exemptions from the minimum performance requirement for providers facing extraordinary circumstances. What types of factors or considerations do you think states should take into account in establishing their criteria for hardship exemptions? 

• States also have flexibility to establish a separate small provider minimum performance level. What types of factors or considerations do you think states should take into account in establishing their criteria for which providers qualify for the small provider minimum performance level? What types of factors or considerations do you think states should take into account in establishing the minimum performance level that small providers need to meet? 

• Do you have recommendations for how bundled payments (those in which multiple services are included in a single payment rates) or alternative payment models should be handled related to the HCBS payment adequacy reporting requirement or the requirement for states to meet a minimum performance level related to the percentage of payments for certain HCBS that is spent on compensation to direct care workers? 

For questions related to the Ensuring Access to Medicaid Services final rule, please email: [email protected]  

For general questions related to long-term services and supports, please email: [email protected]