HCAOA Provides Insight on OMB Meeting Regarding Medicaid 80/20 Access Rule

Last week, HCAOA met with OMB’s Office of Information and Regulatory Affairs (OIRA) after requesting an E.O. 12866 meeting with them in regard to their proposed Medicaid Access Rule.

HCAOA CEO Jason Lee and HCAOA VP of Government Affairs Eric Reinarman led the discussion with officials from CMS and OMB that included HCAOA Board Members Veronica Charles of Maxim Healthcare Services and Matt Kroll of Bayada, as well as HCAOA member Ford Allison from TEAM Services Group. 

HCAOA broached the grave concerns members have regarding the 80/20 provision of the Access rule but also mentioned the many things we support within the rule. Our first point was that the 80/20 provision within the rule prescribes how we must use current Medicaid funding rather than addressing the real issue underlying the workforce crisis: the inadequacy of the reimbursement rates themselves. The rates are already too low and leave us no leeway as it is. We emphasized that increasing reimbursement rates and offering an enhanced FMAP are the most effective and efficient ways to raise caregiver wages.

Our second point surrounded the idea that restricting costs and prescribing how we use reimbursement rates through a rigid 80/20 proportion would contradict many of the quality measure efforts that we actively support in the proposed rule. This is a time when the industry needs more support and more innovation, not less funding and more regulation.

Our third point involved the fact that negative impacts to patient access nationally will unfortunately be swift and severe if this rule is handed down in final form as written. Most providers will curtail services, while many will leave the Medicaid space entirely. In fact, the 80/20 provision will only serve to reduce access, contradicting the purported goal of the proposed rule.
 
More specifically, we emphasized that while we are incredibly concerned by the 80/20 provision of the proposed rule, given how many patients are likely to lose services, we support many of the provisions in this proposed rulemaking surrounding quality measures. We specifically support Access Reporting requirements [2 CFR §441.311(d)], Payment Rate Transparency [42 CFR §447.203(b)(1)], HCBS Quality Measure Set creation [42 CFR §441.312] and many others.
 
Unfortunately, many of these provisions will be undercut by the imposition of an 80/20 mandate. For example, the quality measure set. This first-of-its-kind quality measure set has set out to promote consistent quality measures intended to provide insight into the quality of HCBS programs. While we have been fully supportive of this effort, we strongly believe the 80/20 provision of this proposed rule will instead restrict clinical supervision, enhanced training, provider workforce programs, and background checks, all of which are steps that providers currently take and fund to ensure a quality HCBS workforce. The rule simultaneously seeks to improve quality and impose stricter quality measures while constraining costs and payments for services. We stressed that it is very, very difficult for these priorities to co-exist.

As E.O. 12866 meetings do not allow OMB or CMS to answer questions regarding pending rules, government officials did not provide a tentative release date for the rule. 

HCAOA will keep members up to date on this rule.