The Centers for Medicare and Medicaid Services (CMS) recently released
guidance on the HCBS Payment Adequacy Reporting Requirements, which was finalized in
2024 Access Rule. In this guidance, CMS refers to it as the “direct care worker compensation reporting” requirement.
The Payment Adequacy Reporting Requirements specify that:
- Beginning July 9, 2028, states must report annually to CMS on the percentage of total Medicaid payments (excluding non‑allowable costs) for homemaker, home health aide, personal care, and habilitation services that is spent on direct care worker compensation.
- States must report separately for each service, and within each service must report separately on self-directed services, and services delivered in a provider-operated physical location where facility-related costs are included in the payment rate.
- One year prior to the applicability date, states must submit a readiness assessment to CMS outlining their ability to comply with the reporting requirement.
The new guidance provides several clarifications, including:
- A detailed description of the reporting requirement.
- Definitions for homemaker, home health aide, personal care, and habilitation services to support state alignment with the Rule.
- A definition of compensation, calculation instructions, and common data sources for reportable information.
Please contact NCAL’s Director of Policy and Regulatory Affairs Jill Schewe with questions.