On April 22, the Centers for Medicare and Medicaid Services (CMS) released the Medicaid Program: Ensuring Access to Medicaid Services final rule for public inspection. The rule is often referred to as the Medicaid Access Rule or the 80/20 rule. The rule will post to the federal register on May 10, with an effective date 60 days following, or July 9.
The rule imposes significant requirements on states aimed at improving access to services and quality of those services. Beyond the state-level compliance requirements, this rule will give states four years to develop reporting structures and standards for some home and community-based services providers in the Medicaid program. At present, these providers are homemaker, home health, personal care, and habilitation. Additionally, providers of homemaker, home health, and personal care services will need to demonstrate, in six years through this reporting, that 80% of their Medicaid rate is passed on to direct care staff. In addition to these, states will now need to adopt standard quality measures for home- and community-based services, make changes to critical incident management programs and reporting, impose more stringent minimum participation of beneficiaries on advisory groups, and publicly post substantial reporting and transparency on waitlists, access to services, rate setting and payment, among others.
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