Association Executive Directors Community

Dear Association Executives - It is a busy week for federal regulations. HHS' Centers for Medicare & Medicaid Services (CMS) has issued two final rules regarding Medicaid – 

1. Its Ensuring Access to Medicaid Services final rule regarding fee-for-service (FFS) and managed care, inclusive of home- and community-based services (HCBS), and
2. Its final rule on access to managed care plans in Medicaid and Children's Health Insurance Program (CHIP). 

Fact sheets for these rules can be found respectively here and here. 

At a high level, several finalized provisions to note include the:

• Requirement for states, in six years, to generally ensure a minimum of 80% of Medicaid payments for homemakers, home health aides, and personal care services be spent on compensation for direct care workers furnishing these services.
  • CMS finalized modifications to the rule by adding a definition of excluded costs for the calculation of the percentage of Medicaid payments to providers that is spent on compensation for direct care workers.
• Requirement for states to compare their fee for service (FFS) payment rates for primary care, obstetrical and gynecological care, and outpatient mental health and substance use disorder services to Medicare rates and publish the analysis every two years.
• Establishment of a maximum appointment wait time standard of 10 business days for outpatient mental health and substance use disorder services if covered in the managed Care Organizations' (MCO's), Prepaid Inpatient Health Plans' (PIHP's), or Prepaid Inpatient or Ambulatory Health Plan's (PAHP's) contract.
• Requirement for states to submit an annual payment analysis that compares managed care plans' payment rates for certain services as a proportion of Medicare's payment rate and, for certain home- and community-based services, the state's Medicaid state plan payment rate.
• Clarification that statutorily required PPS rates to Certified Community Behavioral Health Clinics (CCBHCs) demonstrations under Section 223 are not considered State Directed Payments (SDPs). CMS further noted that if states elect to adopt payment methodologies similar to those under the CCBHC demonstration, but the State or facilities are not part of an approved section 223 demonstration, those payment arrangements would need to comply with SDP requirements in § 438.6(c) as the Federal statutory requirements only extend to those States and facilities participating in an approved demonstration.

Effective dates for these rules are July 2024 and CMS has provided an outline of the various applicability dates for each of these rules here and here.

The National Council has submitted comments on both proposed rules this summer and a National Council analysis of the final rules will be forthcoming. 

Please feel free to share this with your members. We will include information on these final rules in our Capitol Connector on Friday.

Please let me or Katherine Seibel, Manager, Federal and Regulatory Activities (KatherineS@thenationalcouncuil.org) know if you have questions, need support, or if any additional information would be helpful.

Thank you – Reyna

Reyna Taylor
Senior Vice President, Public Policy & Advocacy
Policy Department
National Council for Mental Wellbeing
Direct: 202-774-1651
ReynaT@TheNationalCouncil.org

------------------------------
Neal Comstock
Director of Membership
National Council
NealC@TheNationalCouncil.org
202 748-8793
------------------------------

Dear Association Executives - In follow-up to the update provided earlier this week on CMS' two new Medicaid Access final rules, we have attached an additional document with highlights from these two rules.

Please feel free to share this with your members. We are not otherwise sending this to National Council members.  

If you have any questions or need additional support, please reach out to me or Katherine Seibel, manager, Federal and Regulatory Activities at KatherineS@TheNationalCouncil.org. 

Have a wonderful Friday!

Reyna

Reyna Taylor
Senior Vice President, Public Policy & Advocacy
Policy Department
National Council for Mental Wellbeing
Direct: 202-774-1651
ReynaT@TheNationalCouncil.org

------------------------------
Neal Comstock
Director of Membership
National Council
NealC@TheNationalCouncil.org
202 748-8793
------------------------------

Original Message:
Sent: 04-24-2024 18:13
From: Neal Comstock
Subject: CMS Medicaid Access Final Rules – 4/24/24

Dear Association Executives - It is a busy week for federal regulations. HHS' Centers for Medicare & Medicaid Services (CMS) has issued two final rules regarding Medicaid – 

1. Its Ensuring Access to Medicaid Services final rule regarding fee-for-service (FFS) and managed care, inclusive of home- and community-based services (HCBS), and
2. Its final rule on access to managed care plans in Medicaid and Children's Health Insurance Program (CHIP). 

Fact sheets for these rules can be found respectively here and here. 

At a high level, several finalized provisions to note include the:

• Requirement for states, in six years, to generally ensure a minimum of 80% of Medicaid payments for homemakers, home health aides, and personal care services be spent on compensation for direct care workers furnishing these services.
  • CMS finalized modifications to the rule by adding a definition of excluded costs for the calculation of the percentage of Medicaid payments to providers that is spent on compensation for direct care workers.
• Requirement for states to compare their fee for service (FFS) payment rates for primary care, obstetrical and gynecological care, and outpatient mental health and substance use disorder services to Medicare rates and publish the analysis every two years.
• Establishment of a maximum appointment wait time standard of 10 business days for outpatient mental health and substance use disorder services if covered in the managed Care Organizations' (MCO's), Prepaid Inpatient Health Plans' (PIHP's), or Prepaid Inpatient or Ambulatory Health Plan's (PAHP's) contract.
• Requirement for states to submit an annual payment analysis that compares managed care plans' payment rates for certain services as a proportion of Medicare's payment rate and, for certain home- and community-based services, the state's Medicaid state plan payment rate.
• Clarification that statutorily required PPS rates to Certified Community Behavioral Health Clinics (CCBHCs) demonstrations under Section 223 are not considered State Directed Payments (SDPs). CMS further noted that if states elect to adopt payment methodologies similar to those under the CCBHC demonstration, but the State or facilities are not part of an approved section 223 demonstration, those payment arrangements would need to comply with SDP requirements in § 438.6(c) as the Federal statutory requirements only extend to those States and facilities participating in an approved demonstration.

Effective dates for these rules are July 2024 and CMS has provided an outline of the various applicability dates for each of these rules here and here.

The National Council has submitted comments on both proposed rules this summer and a National Council analysis of the final rules will be forthcoming. 

Please feel free to share this with your members. We will include information on these final rules in our Capitol Connector on Friday.

Please let me or Katherine Seibel, Manager, Federal and Regulatory Activities (KatherineS@thenationalcouncuil.org) know if you have questions, need support, or if any additional information would be helpful.

Thank you – Reyna

Reyna Taylor
Senior Vice President, Public Policy & Advocacy
Policy Department
National Council for Mental Wellbeing
Direct: 202-774-1651
ReynaT@TheNationalCouncil.org

------------------------------
Neal Comstock
Director of Membership
National Council
NealC@TheNationalCouncil.org
202 748-8793
------------------------------