Relief Provisions Not Enough to Mitigate Damage of 80/20 Policy, Providers Say

 McKnight’s Home Care / By Adam Healy

Though newly finalized changes to the Medicaid Access Rule attempted to soften the blow of its controversial 80/20 provision, home care providers remained vehemently opposed to the Centers for Medicare & Medicaid Services’ strict new spending mandate.

“Overall, while there are many positive provisions within the final rule as well as mitigations to make the payment adequacy provision less onerous, NAHC remains extremely concerned about the negative consequences of the pass-through policy,”  the National Association for Home Care & Hospice said in an analysis for NAHC members released after the rule was published. 

Among the mitigating factors in the final rule: CMS extended the time frame for when the 80/20 provision will take effect to six years from four years. The agency also is requiring states to review their Medicaid rates to ensure access. And it is mandating that states report how long it takes beneficiaries to access home- and community-based services, Dan Tsai, deputy administrator and director of Center for Medicaid and CHIP services at CMS, said in a question-and-answer session at a press conference Tuesday. 

“We ensured that there is a period of reporting for every state and provider so that there’s transparency around where every provider is, and there are a whole suite of provisions in the rule that also get at whether the actual rates that the state Medicaid agency is paying for the service is sufficient,” Tsai said in response to a question by a staff writer at McKnight’s Home Care Daily Pulse. “We do that both by requiring a set of … processes in which the states need to review their rates with a whole group of individuals, and whether those rates are sufficient to ensure access.”

Taken together, all of these changes are “very important in making sure the rate itself is sufficient” to support home care agencies and their workers, Tsai said.

CMS also is offering providers relief from the 80/20 provision by modifying the calculation by which certain expenses are factored into the 80% threshold, expanding the types of services that fit under the 80%, and including optional “hardship exemptions” for smaller providers, the NAHC report said. 

Still, these changes will likely not be enough to mitigate the damage that the 80/20 provision is expected to cause, according to NAHC and other providers.

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