For Immediate Release: April 26, 2024
Contact: Jess Davidson at jdavidson@aapd.com; 202-975-0960
WASHINGTON, DC – Earlier this week, the Centers for Medicare and Medicaid Services (CMS) released three final rules that will improve access to care, either through Home- and Community-Based Services (HCBS) or long-term care facilities for people with disabilities and seniors. Far too many disabled people and older adults are denied the opportunity to exercise their civil right to receive care in the most integrated setting possible. Disabled people and older adults in nursing homes routinely experience neglect, worse health outcomes, and lower life expectancy because of inadequate staffing. The rules announced this week, Ensuring Access to Medicaid Services, Managed Care Access, Finance, and Quality, and Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency, will improve both the quality of care received, and the quality of direct care jobs.
Accessing HCBS has been increasingly difficult – many people do not qualify for services, and those who do qualify often stay on years-long waiting lists before they receive assistance. Low pay and worker shortages have compounded these issues. Improving the care economy is vital to keeping disabled people in their homes and communities instead of institutions.
“While it has been a persistent goal of the disability rights movement to end institutional bias and make it possible for everyone who needs it to receive support in their homes, until that day, people in nursing homes deserve high quality care, and the people providing this care deserve dignity in their work,” said Maria Town, AAPD President & CEO. “Those receiving home- and community-based care have struggled to retain and have long-term relationships with high-quality care workers because of low wages and high turnover. We are pleased that the Biden-Harris administration continues to prioritize efforts to strengthen and improve the care workforce that many in the disability community rely on to live with dignity and independence.”
The Ensuring Access to Medicaid Services Rule (Access Rule) will improve access to home- and community-based services by strengthening oversight of person-centered planning and self-determination. The rule also requires states to create a grievance system for HCBS recipients to address problems, as well as an incident reporting system to report abuse and neglect. Importantly, the Access Rule will improve the quality of caregiving jobs — which are mostly held by women, including Black, indigenous, or other women of color and immigrant women — by requiring 80% of Medicaid payments for homemaker, home health aide, and personal care services be spent on compensation for direct care workers, as opposed to administrative overhead or profit. Finally, the Access Rule will require states to have home care rate-setting advisory groups of beneficiaries, home care workers, and other stakeholders to help devise Medicaid payment rates for home care services and compensation for workers.
The Managed Care Access, Finance, and Quality Rule (Managed Care Rule) requires states to have maximum appointment wait time standards, including 15 days for routine primary care and gynecological/obstetrical services, and 10 days for outpatient mental health and substance abuse services. It also requires states to have a website that will serve as a one-stop shop for consumers to access information about eligibility for Medicaid and their state’s Children’s Health Insurance Program (CHIP), compare managed care plans that are offered through the Medicaid or CHIP program, and compare plans based on key factors such as prescription drug formularies, or which healthcare providers participate in each plan. These provisions will ensure that beneficiaries can choose a managed care plan that suits their needs and are able to access the care they need in a timely manner.
The Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Rule establishes, for the first time, national minimum staffing requirements for long-term care facilities that receive Medicare or Medicaid funding, to ensure the safety and care of residents. The rule also establishes enhanced facility assessment requirements and creates a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. It also has enough flexibility in its implementation to allow for rural facilities to implement the rule in a manner that will suit their needs.
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