Home and Community-Based Services (HCBS) Provisions

The Ensuring Access to Medicaid Services final rule (Access Final Rule) advances access to care and quality of care, and will improve health outcomes for Medicaid beneficiaries across fee-for-service (FFS) and managed care delivery systems, including home- and community-based services (HCBS) provided through those delivery systems.  Specifically, the HCBS provisions of the rule make sweeping changes intended to strengthen necessary safeguards to ensure health and welfare, promote health equity for people receiving Medicaid covered HCBS, and achieve a more consistent and coordinated approach to the administration of policies and procedures across Medicaid HCBS programs by:

• Strengthening oversight of person-centered service planning in HCBS
• Requiring states to meet nationwide incident management system standards for monitoring HCBS programs
• Requiring states to establish a grievance system in FFS HCBS
• Requiring states to report on the percentage of payments for certain HCBS that is spent on compensation for direct care workers
• Requiring that a minimum percentage of payments for certain HCBS is spent on compensation for direct care workers, subject to certain flexibilities and exemptions
• Requiring states to report on waiting lists in waiver programs and on service delivery timeliness for certain HCBS
• Requiring states to report on a standardized set of HCBS quality measures and setting requirements for CMS to develop and update the measure set
• Promoting public transparency related to the administration of Medicaid covered HCBS through public reporting of quality, performance, and compliance measures

Basic information on the Access Final Rule, including the HCBS provisions, was presented on the July 16, 2024 Medicaid and CHIP All State Call.  A summary of applicability dates is also available, and CMS will be hosting a training series specific to the HCBS provisions.  CMS will post additional guidance as it is available.  For any additional questions regarding the HCBS provisions of the Access Final Rule, email HCBSAccessRule@cms.hhs.gov.