CMS Finalizes Two Rules Related to Medicaid Payments

The Biden administration finalized rules that would increase transparency and increase protections for Medicaid members in managed care plans. It also finalized the Ensuring Access to Medicaid Services Rule on Monday that requires home care providers to use a minimum of 80% of Medicaid payments to pay aides and nurses.

The new regulations for Medicaid managed care organizations (MCOs) will be phased in over six months and will ask states to increase reporting on spending by Medicaid insurers and how their rates compare to Medicare. Modern Healthcare notes that they would also be required to survey enrollees about their experiences with insurance companies.

Modern Healthcare reports that the rule is part of the administration’s efforts to build up the nation’s home-based care industry. The rule will also require states to increase transparency for home- and community-based services payment. This will require states to create home care and rate-setting advisory boards.

The Centers for Medicare and Medicaid Services press release on the rules explains that they build on the president’s goals for reforming caregiver compensation. From U.S. Department of Health and Human Services Secretaary Xavier Becerra:

We are taking important steps to strengthen care provided through Medicaid and CHIP, and establishing national staffing standards for nursing homes to enhance care for residents while improving conditions for workers. This will help ensure that millions of people have access to high-quality healthcare and that the dedicated workers who provide care to our loved ones are fully valued for their work.