Federal Access to Medicaid Services Rule
In April 2024, the Centers for Medicare and Medicaid Services (CMS) issued the Ensuring Access to Medicaid Services (Access Rule) final rule regarding member access to care and quality of care. The intent of the Access Rule is to 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.
The requirements contain 13 separate sections, each with its respective deadlines and changes. The first of these sections is due in July 2025. The remainder of the sections have due dates that run subsequently through July 2030. These dates are current as of February 2025 but may be adjusted in response to changes in Federal policy or guidance. To find the full extent of the language, refer to the Federal Register for more details.
Goals of the Access Rule
- Improve access to care, quality, and health outcomes
- Address health equity issues
- Increase transparency and accountability
- Standardize data and monitoring
- Promote beneficiary engagement
Send questions to the Waiver and Compliance team at HCPF_hcbswaivers@state.co.us
Timeline
2025
2026
- July 9, 2026
- Grievance Systems for FFS
- Payment Rate Disclosure
- Comparative Rate Analysis Publication
- Interested Parties Advisory Group
- September 9, 2026
- HCBS Quality Measure Set - for Money Follows the Person (MFP) Grantee States
Projects
Advisory Committees
The new Access Rule requires each state to create a Medicaid Advisory Committee (MAC) and a Beneficiary Advisory Committee (BAC). There are requirements regarding membership and application process. HCPF staff are working to integrate current Night MAC processes with federal requirements for MAC/BAC. Additionally, the State agency must establish an advisory group for interested parties (Interested Parties Advisory Group) to advise and consult on provider rates for certain services under the Medicaid State plan, 1915(c) waiver, and demonstration programs, where payments are made to the direct care workers.
Visit Medicaid Advisory Committee website
Grievances
The Access Rule requires each state to create a grievance (complaint) process. This process would allow members and their representatives to file a complaint with the HCPF directly about the Person-Centered Service Planning (PCSP) process and the Home and Community Based Services (HCBS) Settings requirements. The Access Rule creates requirements for individuals’ accessibility including language, readability, and other obstacles.
Comparative Rate Analysis
The Access Rule requires assurance from the State that payment rates are adequate to ensure enough direct care workers are employed to meet the needs of members and provide access to services in the amount, duration, and scope specified in the member’s person-centered service plan.
Quality Measure Set
Starting July 9, 2028, CMS requires biennial reporting on mandatory measures in its HCBS Quality Measure Set, with state-established performance targets and quality improvement strategies. States that are a Money Follows the Person (MFP) grantee will be required to submit a report in the fall of 2026. This Measure Set also includes responses to member experience of care surveys.
Critical Incidents and Electronic Systems
The Access Rule requires that States report on the operation and maintenance of a critical incident management system that identifies, reports, triages, investigates, resolves, tracks, and trends all critical incidents for members participating in HCBS. Critical incidents must be reported in identified timelines and using specified federal guidelines. A Critical Incident Reporting (CIR) system must be in place for trending and follow up. HCPF is working with internal teams creating these systems in conjunction with the Care and Case Management System.
Person-Centered Service Plan
The Access Rule requires that States report on their person centered planning processes. Person Centered Planning must be done annually, at a minimum, and must include the member receiving services. Revisions to the Person-Centered Plan must be done when change in circumstance or need occurs.
Website Transparency
States must have a centralized website to host required information identified by CMS. The website must meet certain requirements for accessibility including plain language. Reports required in the Access Rule will be posted to the website in a transparent and user-friendly manner.
Waitlists
States must report to CMS on the number of people on a waitlist for HCBS. States must include information about how the list is maintained and about how long people wait on the list before receiving services.
Colorado only has a waitlist for the Developmental Disabilities waiver. Contact your local Case Management Agency for more information.
Timeliness of Access to HCBS
States must report annually to CMS on timeliness of access to:
- Personal care services
- Homemaker services
- Home health aide services
- Habilitation services
The report must include:
- The average amount of time from initial service authorization to the initiation of services
- The percent of authorized service hours actually provided in the past 12 months, for individuals newly receiving services
HCBS Payment Adequacy
States must ensure that a minimum of 80% of payments for Homemaker, Home Health Aide, and Person Care services, be spent on compensation for Direct Care Workers. Compensation includes wages, salary, training, and benefits, as opposed to overhead or profit.