In a series of posts, Myers and Stauffer will highlight home and community-based services (HCBS) and rate setting methodologies that can have a tremendous impact on services with state programs.
States are required to review their home and community-based services (HCBS) rate-setting methodologies, at a minimum, every five years with their HCBS waiver renewal. The role of the State Medicaid Agency in developing rates is described in 42 CFR §447.201: “The plan must describe the policy and the methods to be used in setting payment rates for each type of service included in the State’s Medicaid program.” This required timeframe provides a fixed period in which states are required to update their waivers and the supporting rate methodology. The funding available through the American Rescue Plan Act (ARP) has provided an opportunity for states to examine their HCBS programs for areas that can be strengthened. This examination can result in new services, updated service descriptions, new waivers to meet different population needs, and updated rates that reflect changes to workforce and administrative costs.
While ARP and waiver renewals provide an opportunity for states to update their waivers and rates, they are often time-sensitive and limited projects. The requirements included in renewing a waiver or updating rates can overtake the process and make it difficult for states to find the extra time needed to engage stakeholders, review service descriptions to match how services are provided, and reflect the current needs of the population. Yet, these are critical steps to take before engaging in the administrative tasks necessary to renew the waiver or update rates.
How We Can Help
Myers and Stauffer has a strong history of helping clients develop and design waivers, implement rate reimbursement structures, and conduct stakeholder engagement, all with the goal of strengthening HCBS programs. We work with our clients and stakeholders to create population or program-specific solutions that meet each state’s desired goals and outcomes. For more information, please contact us or see our HCBS whitepaper below: