CMS - content management system
(Credit: gustavofrazao / Getty Images)
CMS - content management system
(Credit: gustavofrazao / Getty Images)

A proposed federal rule establishing mandatory quality measures for home- and community-based services and requiring providers to allocate 80% of HCBS payments to direct care worker pay is one step closer to being finalized.

The White House Office of Management and Budget’s Office of Information and Regulatory Affairs has completed its review of the Centers for Medicare & Medicaid Services’s so-called Medicaid Access Rule, according to the agency’s website.

The review, which began in January, was completed yesterday. No further details were available, but CMS has indicated that it plans to issue a final rule this month.

The federal agency said that the rule is meant to “support and stabilize the direct care workforce” in home- and community-based settings, but several senior living industry advocacy groups previously said that it ultimately could lead to fewer jobs, stagnant pay for caregivers and a reduction in older adult access to HCBS — the exact opposite of what the government intends.

Also, quality measures that are part of the proposed rule have the potential to burden assisted living providers financially and administratively, some of the groups said in comments to the federal agency.

The American Seniors Housing Association, Argentum, LeadingAge and the National Center for Assisted Living were among the more than 2,000 groups and individuals submitting comments to CMS on the rule, formally titled “Medicaid Program; Ensuring Access to Medicaid Services,” which the agency had proposed last April. Between 18% and 20% of all assisted living residents receive Medicaid services under state HCBS programs and waivers, Argentum President and CEO James Balda said in his comments.

Although the advocacy groups said they generally support the intentions behind the proposed rule and its provisions, as well as a living wage for direct care workers, a common theme among their comments was disagreement with the spending-related requirement.

In February, 11 Republican senators sent a letter to CMS Administrator Chiquita Brooks-LaSure sharing their concerns that the rule could diminish older adult access to services and hamper providers’ workforce retention efforts.

White House review of another rule of high interest to senior living providers, which would create a new threshold for overtime pay eligibility, was completed last week. A final overtime rule also is expected to be issued this month.

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