Implementation of the Ensuring Access to Medicaid Services (CMS-2442-F) Final Rule: Part 4
Payment Rate Transparency 42 CFR § 447.203(b)(6): Interested Parties Advisory Group
On May 10, 2024, the Centers for Medicare & Medicaid Services (CMS) published a final rule titled: Medicaid and Children’s Health Insurance Program (CHIP) Ensuring Access to Medicaid Services (CMS-2442-F). As we previously summarized in our May 2024 client alert, the final rule rescinds the existing access monitoring review plan (AMRP) requirements at 42 CFR § 447.203(b) and replaces them with new requirements for Medicaid fee-for-service (FFS) payment rate transparency.
To assist states in complying with these requirements, in July 2024, CMS published a Guide for States titled Ensuring Access to Medicaid Services – A Guide for States to the Fee-For-Service Provisions of the Final Rule. The Guide for States outlines comprehensive instructions relating to these requirements. We have included below a table from the Guide outlining the key provisions and applicability (compliance) dates.
| Part | Regulation Section(s) in Title 42 of the CFR | Applicability Dates* |
| 1 | Payment Rate Transparency Publication § 447.203(b)(1) | July 1, 2026, then updated within 30 days of a payment rate change. |
| 2 | Comparative Payment Rate Analysis Publication § 447.203(b)(2) to (4) | July 1, 2026, then every 2 years |
| 3 | Payment Rate Disclosure § 447.203(b)(2) to (4) | July 1, 2026, then every 2 years |
| 4 | Interested Parties Advisory Group § 447.203(b)(6) | The first meeting must be held within 2 years after effective date of the final rule, then at least every 2 years. |
| 5 | Rate Reduction and Restructuring SPA procedures § 447.203(c)(1) and (2) | July 9, 2024 |
This Client Alert Addresses Part 4 – Interested Parties Advisory Group
42 CFR § 447.203(b)(6) requires state Medicaid agencies to establish and convene an Interested Parties Advisory Group by July 9, 2026. The Advisory Group will advise and consult on certain fee-for-service (FFS) home and community-based service (HCBS) provider rates authorized under the state plan, 1915 (c) waivers, and demonstration programs. These services include payments made to direct care workers providing self-directed and agency-directed personal care, home health aide, homemaker, and habilitation services. States may also include additional HCBS and may choose to have the Advisory Group consult on these provider rates where the services are available through managed care delivery systems.
Key Requirements
- The Advisory Group will advise and consult with the state regarding payment rates, HCBS payment adequacy data, and access to care metrics to ensure rates are sufficient to allow for access to homemaker, home health aide, personal care, and habilitation services. Access for Medicaid beneficiaries is considered sufficient if available services are at least as great as those available to the general population in the geographic area and ensure an adequate number of qualified direct care workers.
- The Advisory Group must include direct care workers, beneficiaries and their representatives, and other interested parties affected by the Medicaid rates.
- The final rule permits states to use their Medicaid Advisory Committee (MAC) to fulfill the Advisory Group’s responsibilities, provided the MAC includes direct care workers, beneficiaries and their authorized representatives, and other interested parties impacted by payment rates for personal care, home health aide, and homemakers services. However, the roles of Advisory Group and the MAC must remain distinct and should not interfere with the other’s requirements.
- States are responsible for providing the Advisory Group with appropriate training, guidance, and context to support informed and useful recommendations.
- The Advisory Group must have access to current and proposed payment rates, HCBS provider payment adequacy minimum performance and reporting standards (as required under 311(e)), and applicable HCBS access to care metrics (as required under 441.311(d)). The state must ensure this information is made available to the Advisory Group with sufficient time to produce recommendations on the adequacy of direct care worker payment rates.
- The first Advisory Group meeting must be held within two years of the effective date of the final rule (by July 9, 2026) and at least every two years after. CMS stresses that this is a minimum requirement and more frequent meetings may be necessary to help the Advisory Group make meaningful recommendations.
- The two-year meeting cadence may initially result in the Advisory Group meeting before the HCBS payment adequacy data and access to care metrics are available. The CMS Guide for States clarifies that the Advisory Group is not required to advise and consult on this data until such a time as the data is available.
- The state must publish the Advisory Group’s recommendations within one month of receiving their report. States are intended to consider, but not required to adopt, these recommendations.
How Myers and Stauffer Can Help
Myers and Stauffer has nearly 50 years of Medicare and Medicaid experience and expertise in the required principles for setting rates and developing payment systems. For many of our rate setting engagements, our procedures include calculating reimbursement rates, developing rate schedules for publication, preparing comparisons to Medicare, facilitating stakeholder engagement, and other activities that support accurate and transparent reimbursement rates. Our experienced team is ready to support states in ensuring timely compliance with the federal rate transparency requirements.
| Tim Guerrant, CPA Member |
Jared Duzan, CFE Member |
Joe Gamis, CFE, MBA Principal |
| Jeffery Marston Member |
Daniel Brendel Principal |
Tara Clark, CPA Member |
| John Dresslar, CPA Member |
Bobby Courtney, MPH, JD Principal |
Megan Frenzen, MBA, MSc, PhD Principal |
| Scott Price, CPA, CFE, PMP, CGMA Member |
Krista Stephani, CPA Member |
