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Pennsylvania Medicaid Home & Community Based Services (HCBS) Rates have been updated and take effect January 1, 2025.
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The Centers for Medicare & Medicaid Services (CMS) has finalized a home health prospective payment rule for 2025 that includes a 0.5% aggregate increase in Medicare home health reimbursement, translating to approximately $85 million. This adjustment marks a shift from the proposed 1.7% decrease, reflecting ongoing adjustments related to the Patient-Driven Groupings Model (PDGM). Despite this improvement, stakeholders in the home health sector expressed dissatisfaction, emphasizing that the overall trend has been toward significant cuts and insufficient recognition of inflationary pressures on costs.
HCAOA joined NAHC, LeadingAge, ANCOR, and other industry leaders for a quarterly meeting with the Centers for Medicare and Medicare Services (CMS) last week as CMS continues to seek feedback regarding the implementation of the Medicaid Access Rule. Throughout the meeting, our coalition of industry leaders continued to stress the potential impact of the 80/20 provision on providers and provided recommendations for sub-regulatory guidance that has yet to be articulated by CMS, such as reporting and audit requirements, to ensure state-by-state continuity in implementation and to mitigate unnecessary administrative burden on providers.
A recent report from the University of California San Francisco (UCSF) highlights significant barriers preventing seniors with cognitive impairment from accessing home care services. Approximately 4.3 million seniors in the U.S. live alone with cognitive challenges. Yet, nearly 80% cannot obtain home care aides through programs like Medicaid due to their ineligibility to qualify for Medicaid. Many of these seniors struggle with daily activities and receive little to no assistance from family or friends.
HCAOA Associate Member Paradigm has launched a new resource for home care agencies. The Medicaid Rate Lookup Tool is crafted to streamline access to Medicaid reimbursement rates and service details for home care agencies. It provides quick insights into service rates, claim filing periods, and state-specific Medicaid information.
 The Centers for Medicare & Medicaid Services (CMS) is launching a training series focused on the home- and community-based services (HCBS) provisions of the Medicaid Access Rule. This final rule, aimed at improving access to care, quality of care, and health outcomes for Medicaid beneficiaries, introduces significant changes to strengthen safeguards, promote health equity, and enhance the consistency of Medicaid HCBS programs. The training sessions will cover key provisions of the rule, providing partners with the opportunity to understand the updates, ask questions, and give feedback on the rule's implementation.
 Thanks to aggressive advocacy by the HCAOA West Virginia Chapter, the state’s HCBS reimbursement rate has been raised from $18.92 to $25.44, a 34.5% increase! This increase makes West Virginia’s rates more competitive with surrounding state rates, such as Kentucky (soon to be $29), Ohio ($29), Maryland ($31), Pennsylvania ($23 regional average), and Virginia ($23 regional average).
 CMS has published a new fact sheet about the services available through the Guiding an Improved Dementia Experience (GUIDE) Model, along with guidance on how patients and families can work with their healthcare providers to access GUIDE services and supports. GUIDE focuses on dementia care management and aims to improve the quality of life for people living with dementia, reduce strain on their unpaid caregivers, and enable people living with dementia to remain in their homes and communities.
 This webinar will help states by:
 All providers are invited to participate in CMS’ Open Door Forum on Tuesday, July 30 at 2:00 p.m. for an 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.”
 Last week, the Georgia Department of Community Health (DCH) informed the HCAOA Georgia Chapter that it received approval from CMS for the Independent Care Waiver Program (ICWP) and Elderly and Disabled Waiver Program (EDWP) amendments submitted in May. The waiver amendments for both ICWP and EDWP were approved with an effective date of July 1, 2024.
 Change Healthcare said it has begun notifying people who were impacted by the cyberattack on patient data in February. (press release)
 As HCAOA has reported previously, several rate increases for Medicaid providers of home and community-based services (HCBS) in Georgia were included in the SFY 2025 budget, which was signed in May and later approved by the Georgia Department of Community Health. The increases were then sent to CMS for their approval prior to implementation. CMS has submitted a series of questions to DCH concerning these rate increases and responses have already been submitted. DCH continues to work closely with CMS to facilitate the final approval of the rate increases, and based on the current status, the goal continues to be an effective date of July 1.
CMS Projects Health Care Spending to Increase Over Next 10 Years, Outpacing Overall Spending6/19/2024  Between now and 2032, the average annual growth in health care spending will outpace overall spending, resulting in an increase in the health spending share of GDP from 17.3% in 2022 to 19.7% in 2032, according to an annual report released last week by the CMS Office of the Actuary. Personal health care price inflation and growth in the use of health care services and goods contribute to projected health spending that grows at a faster rate (5.6%) than the rest of the economy (4.1%).
 Last year, Washington became the first state in the U.S. to launch a self-funded, long-term care insurance program. The plan, dubbed WA Cares, is self-funded by worker contributions only while they are working to fund long-term care benefits later in life. The HCAOA Washington Chapter has been advocating to ensure that private pay home care agencies and Medicaid agencies have the same opportunity to provide care under the plan, and the group recently took a closer look at the Fund during its Chapter Conference on May 23.
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