What are the Home and Community Based Services Access Rules?
In April 2024, The Centers for Medicare & Medicaid finalized the Ensuring Access to Medicaid Services (also known as the Access Rule) final rule to support the quality of HCBS programs and add protections for people receiving services.
What are the goals of the HCBS Access Rules?
- Include people receiving services.
- Make it easier to get care and services.
- Improve quality and health outcomes.
- Increase transparency and accountability.
- Standardize data and monitoring.
What are the HCBS Access Rule Areas?
Advisory Groups
The new Access rule requires each state to create advisory committees. This will be a place for members to share their lived experience to help make sure Medicaid is working well.
Medicaid Advisory Committee
The Medicaid Advisory Committee gives advice to the Health Care Authority on Apple Health services and policies. Members include Apple Health clients, providers, and organizations and agencies that support Apple Health.
- Community advocacy groups
- Clinical providers or administrators
- Managed care plans
- Other state agencies
- Beneficiary Advisory Council members
What you’ll do:
- Share ideas on how to improve Apple Health.
- Give feedback on policy and administration.
- Meet every other month.
For more information, please visit the Apple Health Medicaid Advisory Committee Website.
Beneficiary Advisory Council
The Beneficiary Advisory Council is a collaborative group of people who draw on their lived and living experiences to provide insights that will help co-create Apple Health policies, services, and programs in partnership with HCA. Council membership is currently full. Nine members were selected to serve for the current term.
- Current and former Medicaid beneficiaries
- Family members
- Caregivers
What members do:
- Share your Apple Health experience.
- Help improve services and client materials.
- Meet online four times a year.
For more information, please visit the Apple Health Medicaid Beneficiary Advisory Council Website.
Grievance System
This is a process for people to speak up if they have a problem with their home and community-based care or care-related services. If something isn’t working the way it should with care services or providers, this system makes sure concerns are heard and reviewed.
Incident Reporting
A way to notify the right people about serious problems, like abuse, neglect, or medical mistakes that could hurt someone. Incident reports are part of the system of investigating, tracking, and fixing problems so people are protected.
Person Centered Plans
- Support people in making choices about their care.
- Ensure each person’s needs and wishes are followed when planning services.
Wait List and Timeliness of Access to HCBS
- Focus on people getting support they need quickly.
- Track the time for services to start after requested and approved.
- Report hours of support used.
- Report and improve wait times.
Quality Performance and Compliance Measures
- Checks if Medicaid services are working the way they should.
- Track problems, measure service quality, and suggest ways to improve.
Website Transparency
Make sure the website is in plain language so that people can find the information they need. Information is available in different languages and formats, including audio and video. Shows people information about services and ways to report problems and get answers.
HCBS Payment Adequacy and Payment Rates
- Makes sure caregivers and service providers are paid fairly.
- Helps people understand how Medicaid money is spent.
- Supports a stable workforce to help Medicaid clients connect with care when and where they need it.
At least 80% of all Medicaid payments for personal care, homemaker, and home health aide services must go to direct care workers. Includes salary, wages, benefits and taxes.
Direct care workers include:
- Direct service providers
- Most nurses
- Nurse practitioners
- Licensed or certified nursing assistants
- Personal care attendants
- Home health aides
- Others who are paid to help Medicaid clients live, work, and stay active in their home or community. (Activities can include help with daily tasks, support for managing behaviors, finding and keeping a job, and assistance with staying active in the community.)
- Others directly providing services