CMS Open Door Forum Focuses on Payment Adequacy Provisions in Medicaid Access Rule

CMS Open Door Forum Focuses on Payment Adequacy Provisions in Medicaid Access Rule

Home» CMS Open Door Forum Focuses on Payment Adequacy Provisions in Medicaid Access Rule

The Centers for Medicaid Services (CMS) Open Door Forum (ODF) was hosted by the director, Alyssa DeBoy, and the deputy director, Melissa Harris, from the Medicaid Benefits and Health Programs Group. This group oversees state waivers and programs related to home and community-based services.

Harris reviewed a few slides providing high-level requirements of states from the entire rule, then focused in on payment adequacy and related transparency provisions. The Medicaid: Ensuring Access to Medicaid Services Rule was finalized on May 10, with an effective date of July 9 with robust requirements on states ranging from revamping stakeholder processed and groups and critical incident management programs to developing payment rate reporting standards and holding providers to payment adequacy provisions.

The most talked about provisions of the rule were the payment adequacy provisions; those that would require 80% of Medicaid payments for home maker, home health, and personal care services to be passed on to direct care workers through compensation. While there was no new policy guidance offered during the call, Harris thoughtfully shared the work CMS is undertaking to develop and release a collection of additional sub-regulatory guidance around these provisions. She agreed with audience concerns and reiterated that CMS recognizes that states need more information on how to handle bundled services and how states should determine if specific services are covered under the rule since they may have multiple services in different waivers or programs that resemble the stated services.

Harris was also careful to address that CMS does not have authority to direct states to raise provider rates, and believes they are using the levers available to them to compel states to bring providers and other stakeholders to the table in developing a compliance plan for the payment adequacy provisions.

Harris made two useful clarifications:

• Regarding the exclusion of training from the calculations- costs associated with training of direct care staff such as developing training and hiring a trainer would not be included in the 80%, though wages of direct care staff while staff are being trained would be eligible for inclusion in the 80%.
• CMS has the ability to waive reporting requirements of states that implement small provider and hardship exemptions if the combined number of providers falling under both exemptions is less than 10% of providers offering that service in the state. Our prior interpretation was that either of these exemptions individually could see reporting requirements waived if covered providers comprised less than 10% in each exemption.

The transcript and Q&A will be posted on the CMS ODF page in a few days under the Long-Term Services and Supports drop down. Follow the LeadingAge serial post containing all updates, summaries, and comments on the rule.