CMS NEWS- CMS-proposed HCBS rules elicit request for extension of comment period from 5 associations

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[MM Curator Summary]: We’d like a little more time to weigh in on the giant spotlight CMS wants to shine on HCBS quality issues, pretty please.


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The executive directors of five national organizations are asking the Centers for Medicare & Medicaid Services to extend by at least 30 days the comment periods for two proposed rules related to access to care and managed care finance, access and quality in the Medicaid program and the Children’s Health Insurance Program. The current deadline is July 3.

CMS announced the two proposed rules April 27, as McKnight’s Senior Living previously reported. Among numerous home- and community-based services-related changes proposed in them, some quality measures for HCBS would become mandatory, states would be required to report every other year on the HCBS quality measure set for their HCBS programs, and the measure set would be updated “at least every other year” in consultation with states and other interested parties.

If finalized, CMS said, the proposed HCBS requirements would supersede and replace the reporting and performance expectations described in March 2014 guidance for Section 1915(c) waiver programs. Some assisted living communities provide HCBS such as personal care and supportive services to residents via those state Medicaid waivers.

CMS released its first-ever quality measure set for HCBS in July 2022, saying at the time that although the measures were voluntary, they were expected to become mandatory in the future. At the time, the agency “strongly” encouraged states to use the standards to assess and improve quality and outcomes in their HCBS programs.

The introduction of the measures, senior living industry advocates said then, came amid “longstanding, chronic underfunding” of HCBS that led to provider workforce shortages. The financial issue needed to be addressed, the groups said, noting, however, that they supported the quality improvement effort in general.

In a letter last week to CMS Administrator Chiquita Brooks-LaSure, the executive directors of ADvancing States, the National Association of Medicaid Directors, the National Association of State Head Injury Administrators, the National Association of State Mental Health Program Directors and the National Association of State Directors of Developmental Disabilities Services said they needed more time to review the CMS-recommended policies, which the groups described as “complex, far-ranging, and touch a diverse array of programmatic areas.” The organizations represent Medicaid directors and leaders of Medicaid home- and community-based services waiver operating agencies.

“As our members embark on an intensive period of work conducting long-paused Medicaid renewals, winding down the COVID-19 public health emergency and its attached flexibilities, and continued management of HCBS investments from the American Rescue Plan, agency bandwidth to thoughtfully respond to regulatory actions of this magnitude by the current July 3 closure of the comment period is extremely limited,” the executive directors said.

The review process for Medicaid renewals involves more than 90 million individuals currently covered by the program, the executive directors pointed out.

“The resources necessary to focus on this work directly impact the ability for our members to carefully review CMS’s proposals, understand their impact, and articulate the resources, systems needs, operational considerations, and other factors necessary to achieve success,” they wrote. “Without additional time for our members to conduct such assessments, CMS may not receive the level of policy and technical feedback that would best situate final regulatory action for successful implementation.”