A policymaker tries to stop the 80-20 rule.
Earlier this week, the “Ensuring Access to Medicaid Services” rule was finalized. The 80-20 provision is arguably the most controversial part of the Medicaid rule. In summary, the provision requires that 80% of Medicaid home and community based services (HCBS) payments be earmarked for direct caregiver reimbursement.
On Thursday, Congresswoman Kat Cammack (R-Florida) introduced a bill that would prevent the U.S. Department of Health and Human Services (HHS) from finalizing the 80-20 rule.
In addition, the legislation would also prevent HHS from implementing similar rules that impose a minimum requirement on how much of Medicaid spending on HCBS goes to direct wages of employees.
Cammack’s reason for introducing this law is her belief that the 80-20 provision will significantly limit access to health care at a time when providers are already struggling to care for patients.
“The Biden administration’s proposed ’80/20′ rule would require states to spend billions on new, unfunded mandates or force HCBS providers to reduce access to health care for those who need it most Cammack said in a press release. “Due to the Biden administration’s top-down requirements, home care agencies cannot keep up with staffing levels and overall levels of care while complying with this rule. It significantly disadvantages millions of Americans and only exacerbates the challenging issues we already face.”
Cammack is not the only person who has raised similar concerns about providers’ ability to provide services under the 80-20 rule.
Executives from organizations such as Home Assist Health, the National Association for Home Care & Hospice (NAHC) and Addus HomeCare Corp. (Nasdaq: ADUS) have opposed the rule for similar reasons.
“It compromises the integrity of our home care network,” Sara Wilson, president and CEO of Home Assist Health, previously told Home Health Care News. “It makes me nervous because it could impact our ability to care for the people we are here to serve.”
NAHC President William A. Dombi took aim at what he said was a contradictory rule.
“At its core, the rule is a fundamental contradiction,” Dombi previously told HHCN. “It means we need to do all of these things to improve the quality of care, to improve lives and the health and safety of individuals. To achieve all of these things requires management costs. But at the same time the rule is: “We are reducing the funds available so that you can carry out the same activities that we need.”
Despite Addus’ opposition to the 80-20 rule, the company believes it is well positioned to push for tariff increases to counteract the impact of the rule.
“The conclusion is that you have to be big,” Addus CEO Dirk Allison said at the Raymond James conference last month. “It’s not just big nationally, you have to be big in a state. If you look at the states where we are very large, we have good access to state government and can work with them on the reasons why we need tax increases, which is necessary for certain state programs to remain competitive if they succeed. We’re working on that.”