On Monday, the Centers for Medicare & Medicaid Services (CMS) published final regulations aimed at improving access to Medicaid and quality long-term care for older adults. These rules implement directives in President Biden’s 2023 Executive Order on Increasing Access to High-Quality Care and Supporting Caregivers. Justice in Aging welcomes these rules as meaningful steps to address gaps in our nation’s care infrastructure. When implemented, these rules can help ensure that older adults and people with disabilities who need help with activities of daily living can get high quality support and that they and their caregivers are treated with dignity. Ensuring Access to Medicaid Services Final Rule The Ensuring Access to Medicaid Services final rule aims to increase access to home and community-based services (HCBS) by establishing mechanisms to ensure adequate payment rates and adequate compensation for direct care workers. The Access rule, along with updates to the Medicaid Managed Care rules, includes other important provisions to address quality and access for Medicaid enrollees to HCBS and Medicaid services more broadly: - Requiring states to have Beneficiary Advisory Committees to ensure people with lived experience are advising state Medicaid agencies.
- Establishing a grievance process for people receiving HCBS in fee-for-service systems.
- Creating new access and quality measures and reinforcing the importance of the person-centered service planning process with increased oversight.
We appreciate CMS expressing interest in many of our recommendations for additional actions to reduce the institutional bias, promote prompt access to HCBS, and identify and address inequities. Nursing Home Minimum Staffing Rule The Nursing Home Minimum Staffing Rule recognizes that inadequate staffing is the leading driver of poor care and establishes long overdue minimum staffing standards for nursing facilities that receive Medicare or Medicaid funding. The rule will require facilities to have a Registered Nurse onsite 24-hours per day, 7 days per week, and to have 3.48 hours per resident per day (HPRD) of total staffing, including a minimum of .55 registered nurse HPRD and 2.45 nurse aide HPRD. The rule also increases transparency by requiring reporting on the percent of Medicaid payments that go directly to compensation for direct care workers. Importantly, the rule also recognizes that these numerical standards establish a floor, not a ceiling, and that higher staffing levels often will be necessary based on the needs of the resident population. Justice in Aging looks forward to working with CMS and advocates to make sure these rules fulfill their promises to address some of the most urgent issues that older adults face in accessing quality care. | |
