CMS Finalizes Medicaid Access Rule with 80/20 Wage Pass Through

The Centers for Medicare and Medicaid Services (CMS) finalized the Ensuring Access to Medicaid Services rule with significant updates from the proposed rule. The proposed and final rule broadly updated transparency and stakeholder engagement in Medicaid programs, with the goal of increasing access to and quality of services delivered in Medicaid.

The final rule imposes requirements on states to ensure that providers are passing a minimum of 80% of Medicaid funds for homemaker, home health, and personal assistance services on to workers. CMS has updated some of the definitions to include clinical supervision as an included cost related to direct care and has also outlined their intent to include workers compensation in the 80% threshold. While the final rule includes multiple positive developments-such as the ability of states to establish both separate small provider minimum standards and hardship exemptions-the rule overall maintains provisions that could impose significant challenges on providers. These provisions are on a six-year implementation runway.

The substantial updates from the proposal to the final rule require much more analysis. We will keep members apprised as we work through the details. View the CMS Fact Sheet and contact Georgia ([email protected]) with questions.