Medicaid card and cash atop American flag
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Senior living advocates are applauding steps announced by the federal government to ensure equitable access to home- and community-based services provided via the Medicaid program, but they say that funding remains a sticking point for success.

Thursday, the Centers for Medicare & Medicaid Services proposed two new rules that would make some HCBS quality measures mandatory, as well as place new performance and reporting responsibilities on states and managed care plans. The agency said that the proposed rules are meant to “further strengthen access to and quality of care” across Medicaid and the Children’s Health Insurance Program.

Senior living organizations, however, said they have concerns about inadequate provider reimbursements.

The National Center for Assisted Living applauded CMS for “taking significant steps” to ensure equitable access to healthcare, especially for Medicaid HCBS beneficiaries.

“We support the agency’s efforts to promote quality assurance, person-centered planning, better pay for direct caregivers and address wait lists for HCBS,” NCAL Executive Director LaShuan Bethea told McKnight’s Senior Living. “However, in order to achieve these goals, the linchpin is ensuring that Medicaid is properly funded.”

Argentum said that the participation of assisted living providers in Medicaid HCBS programs allows older adults to receive the care they need in less restrictive settings, saving federal and state governments billions of dollars compared with institutional settings such as nursing homes.

“While national surveys show that residents consistently report an improved health outlook and improved quality of life when they receive care in assisted living communities, Argentum has consistently supported efforts to improve the quality of care of residents receiving long-term services and supports in all instances, including Medicaid HCBS programs,” Argentum President and CEO James Balda told McKnight’s Senior Living. “However, the proposed rule comes at a time when the majority of states provide inadequate reimbursement for HCBS programs utilized in assisted living.”

Quality and reimbursement “go hand in hand,” and inadequate provider reimbursement cannot be separated from the broader issue of care quality improvement, Balda said.

LeadingAge said that more emphasis should be placed on the workforce needs of the aging services sectors, but the association acknowledged the Biden administration for continuing efforts to improve access to HCBS.

“Priority No. 1 is addressing the aging services sectors’ workforce needs,” LeadingAge Vice President of Home Based and HCBS Policy Mollie Gurian said, adding that the association supports the “smart leveraging of resources from across the federal government to increase the number of qualified staff in aging services.”

Increasing transparency on payment rates and managed care contracts, Gurian added, will help drive access to care, but efforts should be made to do so without placing “unfunded administrative burdens” on providers. 

All three associations said they will review the proposed rules and submit feedback to CMS.

The two proposed rules — Ensuring Access to Medicaid Services and Managed Care Access, Finance and Quality — will be published in the Federal Register on May 3, although they are available to view as PDFs now. CMS is accepting comments through July 3. 

If adopted, the rules would establish “historic national standards” for access to care, whether it is provided through managed care plans or by states, according to CMS. Specifically, the rules would establish access standards, as well as transparency for Medicaid payment rates to providers, including compensation for some direct care workers.