This overview is excerpted from Manatt on Health, Manatt’s subscription service that provides in-depth insights and analysis focused on the legal, policy and market developments. For more information on how to subscribe to Manatt on Health, please reach out to Barret Jefferds.
On July 12, CMS released a companion guide to the Ensuring Access to Medicaid Services final rule (the “Access Final Rule”)1. This technical guidance—which focuses on the provisions regarding fee-for-service (FFS) payment transparency, rate restructuring, and the “interested parties advisory group” for certain home and community-based services (HCBS)—is intended to “consolidate and supplement information to help states meet the requirements of the 2024 Access Final Rule once the requirements are in effect.” Although the Access Final Rule’s overall implementation is staged over the next six years, the provisions addressed in this companion guide all take effect by July 2026. Notably, the guide provides information to states on:
- Payment Rate Transparency and FFS Rate Restructuring Provisions. The guidance provides states with an operational roadmap for implementing the FFS rate transparency provisions included in the Access final rule, including state requirements to publish Medicaid FFS fee schedule rates; compare a subset of Medicaid payment rates to Medicare rates; disclose the rates for home care and habilitation services in the form of an hourly wage; and submit an analysis to CMS when proposing to reduce or restructure payment rates. The guidance includes templates states can leverage for each of these requirements, as well as a preliminary list of procedure codes that CMS is likely to include in the comparative payment analysis. The guidance also clarifies certain requirements that were ambiguous in the final rule.
- Interested Parties Advisory Group. The guidance also addresses the requirement that states establish an Interested Parties Advisory Group to advise and consult with the Medicaid agency on payment and access issues for home care and habilitation services. CMS reiterates baseline federal parameters and areas of state flexibility on issues such as how best to select members and convene meetings; share required data with members; communicate members’ roles and responsibilities in producing recommendations; and establish conflict of interest policies.
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1 Click here for more information on the Access Final Rule.