After coordinating with a broad cross section of members and recognizing the strength in collaboration, HCAOA teamed up with the National Association for Home Care & Hospice (NAHC) to develop and submit formal comments to CMS on the Medicaid HCBS proposed rule released in May. Both associations are supportive of many of the provisions in the proposed rulemaking, however did offer suggestions to improve several provisions.
The HCBS Payment Adequacy provision (42 CFR §441.302(k)(3)(i)) is the biggest concern for members, requiring at least 80% of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for the direct care workforce (as opposed to administrative overhead). In the comments, HCAOA and NAHC provide significant analysis and detail to demonstrate why this is problematic for agencies, including the fact that it lacks statutory authority and there is no data to support it.
The comments suggest opportunities to implement regulations that improve the structure and outcomes of state HCBS reimbursements and offer an alternative proposal to enhance HCBS payment methodologies that provide more structure for state rate-setting processes, support and increase worker compensation, and maintain state flexibility and autonomy regarding provider rate setting.
Click here to view the full comments submitted to CMS.