Health Law Highlights

CMS Finalizes Major Reforms to Medicaid, Part 1: Medicaid Access Reg

Summary of article from McDermott+Consulting, by Jeffrey Davis, Kayla Holgash, Katie Waldo:

The Centers for Medicare & Medicaid Services (CMS) has issued two new regulations pertaining to state-operated Medicaid programs, aiming to improve access to care for Medicaid enrollees. A notable policy within the ‘Ensuring Access to Medicaid Services’ regulation specifies that at least 80% of Medicaid fee-for-service (FFS) and managed care payments for home- and community-based services (HCBS) must be allocated towards compensation for direct care workers. The regulation also introduces new definitions, allows for state-specific flexibilities, and outlines reporting requirements for states. Other key provisions include the establishment of a grievance process for beneficiaries, regular review of person-centered service plans, and the creation of a Beneficiary Advisory Council. The regulation will take effect 60 days after publication, but specific provisions have varied effective dates.