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Federal ‘Access to Care’ Medicaid Policy Now Open for Comment

The Centers for Medicare & Medicaid Services (CMS) at the U.S. Department of Health and Human Services (HHS) oversees how states run their Medicaid programs. Occasionally, CMS proposes new rules to improve how Medicaid functions. Before new rules are adopted, CMS puts them out for public comment.

CMS issued a new rule about ensuring access to care on May 3, 2023. Anyone can comment on the proposed rules. We especially encourage people who receive Medicaid and their family members to consider commenting. Comments are due by July 3, 2023.

According to CMS, comments, including mass comment submissions, must be submitted in one of the following three ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to Follow the “Submit a comment” instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2442–P, P.O. Box 8016, Baltimore, MD 21244–1850. (Please allow time for CMS to receive mailed comments before the close of the comment period.)

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–2442–P, Mail Stop C4–26–05, 7500 Security Boulevard, Baltimore, MD 21244–1850.

The proposed rule is long and contains a lot of information. We will introduce the general information this week and follow up with more specific details in the coming weeks. We will also discuss the information on May 24 from noon to 1:00 p.m. CDT in our virtual Leadership Coaching and Policy Discussion. We especially encourage families to attend, but anyone interested in policy is welcome.

We appreciate that CMS includes this statement toward the beginning of the proposed rule: “We have concluded that beneficiary perspectives need to be central to operating a high-quality health coverage program that consistently meets the needs of all its beneficiaries.”

The rule covers these areas:

Advisory Committees: All state Medicaid agencies must have a Medical Care Advisory Committee that includes Medicaid beneficiaries and/or their authorized representatives, such as family members (this is a list of the members of Mississippi’s committee). The proposed rule replaces the Medical Care Advisory Committee with two new committees: a Medicaid Advisory Committee (MAC) and a Beneficiary Advisory Group (BAG). The MAC would advise the Division of Medicaid on a broader range of issues than the current advisory committee does. At least 25% of the members of the MAC must be Medicaid beneficiaries. Beneficiaries comprise the BAG and advise the MAC. The rule requires the state Medicaid Authority to devote sufficient resources, time and staff to the MAC and BAG to ensure that all beneficiaries have the information and support they need to participate meaningfully. It requires open meetings, virtual attendance options and public annual reporting of committee activities.

Home and Community-Based Services: This section emphasizes compliance with the Americans with Disabilities Act and the Olmstead ruling to ensure access to community-based care. It increases standardization across states and payment types and stresses person-centered planning, health and welfare, access, beneficiary protections and quality improvement. It proposes a minimum standard for person-centered planning and requires at least an annual reassessment of functional levels. It outlines more detailed and accountable grievance procedures, allows beneficiaries to submit grievances verbally or in writing and requires states to respond with certain measures within required time frames.

Critical Incidents: The rule requires the state to “establish a minimum standard definition of a critical incident to include, at a minimum, verbal, physical, sexual, psychological, or emotional abuse; neglect; exploitation including financial exploitation; misuse or unauthorized use of restrictive interventions or seclusion; a medication error resulting in a telephone call to or a consultation with a poison control center, an emergency department visit, an urgent care visit, a hospitalization, or death; or an unexplained or unanticipated death, including but not limited to a death caused by abuse or neglect.” It requires states to track this data and report critical incidents electronically. It establishes timelines for responding to critical incidents and outlines coordination with other agencies that protect vulnerable populations.

Access Reporting: The rule requires states to annually report how they maintain waiting lists for home and community-based waiver services if there are limitations on the number of people who can receive such services, how screenings and re-screenings are conducted and how long people stay on waiting lists. It also requires states to report the time between approval for homemaker, home health and personal care services and when those services begin.

Payment Adequacy: The rule requires states to report on the percentage of payment services for homemaker, home health and personal aide services that pay the direct care workers who provide these services.

The rule also discusses implementation timelines for these changes and requests comments on proposed timelines. We will share this information and more details about the proposed rule in the coming weeks.


  • Karen Llanos, (410) 786–9071, for Medical Care Advisory Committee.
  • Jennifer Bowdoin, (410) 786–8551, for Home and Community-Based Services.
  • Jeremy Silanskis, (410) 786–1592, for Fee-for-Service Payment.

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