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ANCOR and Disability Advocates Call for CMS to Consider Supported Employment and HCBS Services in Its Managed Care Network Adequacy Rulemaking

January 29, 2016

The American Network of Community Options and Resources (ANCOR) and a coalition of disability rights advocates are urging the Center for Medicare and Medicaid Services (CMS) to consider both supported employment and Home and Community-Based Services (HCBS) waiver services in its Request for Information (RFI) on “Data Metrics and Alternative Processes for Access to Care in the Medicaid Program.” Final comments on this RFI were due on January 4, 2015. 

The RFI establishes requirements for procedures that states must follow to ensure compliance with the Medicaid Access Provision set forth in Section 1902(a)(30)(A) of the Social Security Act, for services provided through each state’s Medicaid State Plan. Section 1902(a)(30)(A) specifically states that a state program must establish rules for calculating payments for Medicaid-funded services that ensure access to quality, affordable health care and adequate networks of providers in the geographic area. Procedures that ensure that most of the state’s beneficiary population has access to health care services covered under their plans are crucial. ANCOR proposed three things of note in its comments: 

  • That CMS include HCBS waiver programs in its access standards for states. ANCOR argues that other regulations governing HCBS services lack the explicit access protections in these proposed regulations. It also cites multiple occasions on which CMS itself stated that payments for waiver services must be consistent with the Medicaid Access Provision rule. 
  • That CMS specifically consider the unique needs of the intellectual/developmental disability (I/DD) population with regards to access to services when implementing the rule. CMS lists a number of access concerns that affect the I/DD population, including: (1) whether they have meaningful access to services besides physical health care, including supported employment, supported housing, and meaningful integration in the greater community; and (2) whether they have access to health care services that are physically accessible and accessible to people with cognitive disabilities and other communication barriers. 
  • That CMS include additional metrics for access to care that address other important community integration outcomes for this population, including the number of people with I/DD in the competitive workforce, waiting lists statistics, and the relationship between  the adequacy of the health care workforce on the availability of long-term services and supports. 

For further information, read the RFI’s entry in the Federal Register and download a PDF of ANCOR’s comments.