In November of 2015, the Centers for Medicare and Medicaid Services (CMS) issued a long-awaited final rule on Medicaid’s “equal access requirement” laying out methods for assuring access to covered Medicaid Services and accountable rates. HCBS waiver services were left out of the rule, even though the encouragement for the rule was based on a Supreme Court Decision based on HCBS waiver services, Armstrong v. Exceptional Child Center, Inc. The lack of the rule’s inclusion of waiver services was attributed to minimal coverage of rate protections in the HCBS Settings Rule and Managed Care Rules release in 2014 and 2015.
ANCOR felt strongly that there needed to be improved processes for rate setting – many of our members were sharing that their rates were over a decade old or that they were not being properly reimbursed for services and have been tapping into limited reserves. We held Congressional briefings, led Congressional letters to CMS from the Senate and the House, and met with the head of the Centers for Medicaid and CHIP Services to make our point that HCBS services, too, should have coverage by the access rule. As we made progress in this realm, the 2016 elections occurred and the Administration changed.
In 2017, with the Trump Administration at the helm, it became clear that state flexibility was a key goal and that rules like the November 2015 Access Rule would be challenged. In fact, it is one of two rules that CMS has shared publicly that it is revisiting in 2018. We changed course and realized that in order to impact rate processes, we would have to do so in partnership with our state members and associations.
This new direction and tactic led us to bring together key state association executives and staff in our membership to discuss the topline issue we should be addressing through model legislation. The emerging topic became transparency in rates and our work began. ANCOR contracted with a law firm to develop initial language and we held several workgroup calls with state association leaders to refine the model legislation. The legislation is now in its final review with all ANCOR state association members and we hope to finalize it by this March for use in this and next year’s legislative sessions. Once finalized, we will pass the model legislation to our state association members to lead and hone at their specific state level.
We thank our state associations for their hard work and partnership in policymaking and for working with us on a real opportunity to make a difference. If you have any questions about the state model legislation please contact firstname.lastname@example.org or email@example.com.
Esmé Grant Grewal is the Vice President of Government Relations at ANCOR. She can be reached firstname.lastname@example.org.