Rules Advance Access and Quality for Medicaid Services, Including Nursing Homes

This week, the Biden-Harris administration finalized several rules to improve access and quality for people with Medicare or Medicaid. These rules target long-term care facilities, Home- and Community-Based Services (HCBS), and Medicaid managed care. Together, the rules are important steps to ensure that people in these programs, especially those in Medicaid, have the care and coverage they need.

The first rule establishes a minimum staffing standard for nursing homes. Establishing minimum staffing gained traction after the COVID-19 pandemic swept through nursing homes, revealing the full cost of low staffing, low pay, and high worker turnover, but creating a staffing standard is not without controversy. The rule establishes staffing standards for registered nurses (RNs), licensed practical nurses, and certified nursing assistants and also requires facilities to always have RNs on-site. Nursing homes will have several years to bring their staffing into compliance with the new rules.

States must also report the amount of Medicaid money spent in nursing homes on compensation for direct care workers and support staff.

The second rule—the “Access Rule”—requires states to ensure that most Medicaid funding for HCBS goes to direct care workers who provide homemaker, home health, and personal care services. It also requires states to be more transparent about access to HCBS within their state, including reporting on waiting lists; quality, performance, and compliance; and average hourly rates for direct care workers. The rule also increases stakeholder input into how Medicaid functions in the state by creating Beneficiary Advisory Councils (BACs) comprised of Medicaid beneficiaries, their families, and/or caregivers, and expanding the role of Medicaid Advisory Committees (MACs) to provide guidance and oversight of the program.

The third rule—the “Managed Care Rule”—establishes maximum wait time standards, improves network adequacy, increases transparency for both states and managed care plans, and strengthens and clarifies payment and other rules.

These rules all make important advancements in enrollee access to high-quality care, transparency, and accountability. At Medicare Rights, we applaud these steps and will encourage policymakers to build on these improvements to benefit beneficiaries today and in the future.

Read the nursing home staffing rule and fact sheet.

Read the Access Rule and fact sheet.

Read the Managed Care Rule and fact sheet.