The CMS Medicaid Access Rule (officially called the Ensuring Access to Medicaid Services Rule) is a federal rule issued by the Centers for Medicare & Medicaid Services (CMS) in April 2024. It is designed to improve how people access Medicaid services, elevate care quality, increase transparency, and give members and their families a stronger voice in their care delivery. 

CMS created the Access Rule to address concerns about barriers to Medicaid services, inconsistent quality, and limited opportunities for beneficiary input. The rule aims to ensure that Medicaid programs across the country are meeting the needs of members, particularly those receiving HCBS. 

Compliance deadlines vary depending on the specific requirement. Many changes will be implemented in phases over several years. DPHHS will post updated information on this webpage as federal deadlines are confirmed and implementation plans are finalized. 

The Access Rule applies to Medicaid services delivered through both fee-for-service (FFS) and managed care delivery systems. Several provisions have a particular focus on HBCS. DPHHS will communicate which specific programs and populations are affected as implementation progresses. 

The official CMS Access Rule and related resources are available on the Federal Register website, under Medicaid Program; Ensuring Access to Medicaid Services. 

Most members will not see changes to their day-to-day services. Over time, you may notice more opportunities to share feedback, improved processes for resolving concerns, better access to information about your services, and stronger person-centered planning. DPHHS will communicate any changes that directly affect members in advance.

A person-centered service plan is a plan developed with you and those you choose to involve that outlines your goals, preferences, and the services and supports you need.  Your plan will be reviewed at least yearly and updated when your life or needs change. This review will also provide you with a clear channel for raising concerns if something in the plan does not match what you actually need.

DPHHS is currently working to improve its grievance system as part of Access Rule implementation. Information about how to file a grievance will be posted to this webpage when the grievance portal is available.

There are several ways to get involved. You can apply to join the BAC, or you can participate in the public comment portion of the meeting if you are not a member. You can also attend MAC meetings to provide public comment. Check this webpage regularly for upcoming meeting dates and public input opportunities.

DPHHS does not anticipate Access Rule implementation will result in service interruptions. Changes will be made in a phased approach and communicated in advance. If you have concerns about your specific services, please contact your case manager or DPHHS directly.

You can send questions or concerns to Savannah Olsen at savannah.olsen@mt.gov. You may also contact your assigned case manager or service coordinator for assistance with your specific services.

Specific reporting and documentation requirements are still being finalized as DPHHS develops its implementation plans. Providers can expect updates related to quality reporting, person-centered planning documentation, and potentially incident reporting. DPHHS will provide advance notice and technical assistance as new requirements are introduced.

The Access Rule requires Montana to demonstrate that payment rates are sufficient to ensure an adequate supply of direct care workers to meet member needs. DPHHS is conducting rate analysis and reporting as required. Current rate comparison information is available: Access Rules Medicare Rate Comparison SFY 2027 (PDF)

DPHHS will communicate with providers through this webpage, provide bulletins, and other established communication channels. Providers are encouraged to check this page regularly and sign up for any available DPHHS provider communications. 

Quality reporting timelines are being finalized in alignment with federal deadlines. DPHHS will post updated guidance for providers on this webpage as information becomes available.

The BAC is an advisory group made up of Medicaid beneficiaries, their families, and caregivers. It provides a dedicated space for individuals to share direct feedback with DPHHS about Medicaid access and program experiences. Information about how to apply is on the BAC webpage: Beneficiary Advisory Council.

The MAC, also known as the Montana Health Coalition, is a federally required advisory body that provides guidance to DPHHS leadership on health and medical care services. Meeting schedules, agendas, and participation information are available on the MAC webpage.

Advocates and community partners can stay informed by visiting this webpage regularly to check for updates, as well as by attending MAC and BAC meetings and participating in public comment opportunities. DPHHS is committed to keeping partners informed throughout the implementation process.

DPHHS values input from Medicaid members, families, providers, advocates, and tribal partners. Feedback gathered through advisory committees, public meetings, and comment periods will be considered as DPHHS develops and refines its implementation plans. DPHHS will communicate how stakeholder input has shaped decisions when possible.

Rate reporting is required to demonstrate that Medicaid payment rates are adequate to ensure there are enough direct care workers available to meet member needs. This transparency helps ensure members can access services in the amount, duration, and scope outlined in their person-centered service plans.

DPHHS analyzes payment rates in comparison to factors such as Medicare rates, market wages, and workforce availability. This analysis helps identify whether current rates support adequate access to direct care workers across Montana's Medicaid programs.

Payment rates directly influence whether providers can recruit and retain enough direct care workers to serve Medicaid members. Adequate rates help ensure that members can access the services they need when they need them, particularly for home- and community-based services.

DPHHS is committed to meaningful engagement with Montana's tribal partners throughout the Access Rule implementation process. Tribal consultation and input will be incorporated into planning efforts in accordance with state and federal requirements. More information about tribal engagement opportunities will be posted as it becomes available.

Montana's full compliance timeline depends on the specific requirements involved, as different provisions have different federal deadlines. DPHHS is working to develop a phased implementation plan and will post updated timelines on this webpage as they are confirmed.

DPHHS will post updates, meeting information, timelines, documents, and resources to this webpage on an ongoing basis. Stakeholders are encouraged to check back regularly. You may also contact DPHHS directly at savannah.olsen@mt.gov with specific questions.