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ACL Policy Round Up: A new blog feature

August 5, 2021
Vicki Gottlich, Deputy Administrator for Policy and Evaluation

The ACL Policy Round Up is a new blog feature intended to help the aging and disability networks stay informed about new policies (and policy changes) that impact our work, and to ensure our networks are aware of opportunities to provide input on issues that affect older adults and people with disabilities. Please let us know what you think!

This first round-up includes some highlights from the last few weeks.  

Medicaid coverage of non-emergency medical transportation

  • Quick summary: The Consolidated Appropriations Act, 2021 includes language that helps to remove transportation barriers for people with Medicaid seeking needed healthcare. Specifically, the law requires states to ensure necessary transportation for Medicaid beneficiaries to and from covered services; requires states to establish payment rates to ensure that Medicaid beneficiaries have the same access to non-emergency medical transportation (NEMT) as people who are not covered by Medicaid; and establishes new requirements for NEMT providers and drivers. On July 12, the Centers for Medicare & Medicaid Services (CMS) issued an informational bulletin to explain these provisions.   
  • In formulating their plans, states are required to consult with stakeholders, so it’s important for the aging and disability networks to be aware of the new requirements and your state’s planning so that your input can be included.
More Information

For many years, CMS has had regulations requiring states to assure necessary medical transportation for Medicaid beneficiaries, but that requirement was not in the Medicaid law itself. The Consolidated Appropriations Act (CAA), passed in December 2020, changed that. Now, state Medicaid plans must include a single state agency that will provide necessary transportation to beneficiaries and a description of how that agency will do that. In addition, for non-emergency medical transportation (NEMT), the state is required to ensure rates are set to provide beneficiaries with the same NEMT access people without Medicaid have in their area. 

The CAA also adds new NEMT provider and driver requirements (excluding public transit authorities). 

The provider and driver requirements are effective now and apply to any services furnished on or after December 27, 2021. However, exceptions may be made in states that require state legislation to implement any of the new requirements.

Each state will be required to submit a state plan amendment to CMS to show how states are going to meet these new requirements. States also must consult with relevant stakeholders, including those who represent:

  • Patients (including disability advocacy organizations)
  • Medical providers
  • Medicaid managed care organizations
  • Brokers for NEMT
  • Transportation providers (including public transportation providers)

CMS will hold stakeholder meetings to collect general feedback and learn about best practices. We’ll share that information as we have it. 

CMS announces $15M in grants to help states bolster mobile crisis intervention services

  • Quick summary: The Centers for Medicare & Medicaid Services (CMS) announced a $15 million funding opportunity for planning grants to help strengthen system capacity to provide community-based mobile crisis intervention services for those with Medicaid. (The grants are available to state Medicaid agencies.) 
  • Funded by the American Rescue Plan, the grants can be used to support states' assessments of their current services, strengthen capacity and information systems, ensure that services can be accessed 24 hours a day/365 days a year, provide behavioral health care training for multi-disciplinary teams, or to seek technical assistance to develop State Plan Amendment (SPAs), demonstration applications, and waiver program requests under the Medicaid program.
  • This presents an important opportunity for the ACL network to coordinate with state Medicaid agencies and mental health systems to ensure the unique needs of older adults and people with disabilities are addressed as they develop, prepare for, and implement these programs.
More Information

The funding for community-based mobile crisis services is critical, given that:

  • It is estimated that 20% of people age 55 years or older experience some type of mental health concern, including anxiety and mood disorders, and mental health issues are often implicated as a factor in cases of suicide. 
  • Older men have the highest suicide rate of any age group.  
  • Individuals with intellectual and developmental disabilities (I/DD) experience numerous health disparities, including higher rates of mental health symptoms and behavioral challenges, although these difficulties are often misdiagnosed, under-diagnosed, or undiagnosed.

Input needed: Proposed Rules

  • Department of Labor proposed rule prevents sub-minimum wage for federal contractors with disabilities: On July 22, the Department of Labor (DOL) published a notice of proposed rulemaking (NPRM) raising the minimum wage for federal contractors, including people with disabilities. 
    • The proposed rule would implement an executive order signed by President Biden in April, raising the minimum wage for federal contractors from its current rate of $10.95 per hour to $15 per hour, beginning on January 30, 2022. 
    • Most important for ACL’s networks, the proposed rule continues the provisions of the 2014 final rule, which effectively ended the practice of using special certificates issued under section 14(c) of the Fair Labor Standards Act to pay people with disabilities less than the minimum wage for the majority of federal contracts. It ensures that, in most cases, federal contractors with disabilities receive the same minimum wage as other federal contractors. 
    • DOL is currently seeking public comment on the proposed rule. Comments can be submitted online or by mail, and the deadline has been extended through August 27, 2021.
  • Centers for Medicare & Medicaid Services (CMS) proposed rule would increase access to benefits for direct service providers (DSP): The DSP workforce is the backbone of our country’s home and community-based services (HCBS) system. However, low pay and absence of benefits (together with other factors), have caused high rates of turnover and recruiting challenges. These issues have, in turn, created critical workforce shortages and negatively affected the quality, stability, and availability of services.
    • On July 30, CMS published a notice of proposed rulemaking (NPRM) to give states the ability to make health insurance and other employee benefits more accessible to this essential workforce. 
    • The proposed rule would allow state Medicaid agencies to deduct from a practitioner’s Medicaid payment, with the individual’s consent, to pay third parties for benefits such as health insurance and skills training. This creates a pathway for direct service providers and other practitioners to enroll in, pay for, and retain employee benefits. 
    • The proposed rule reverses a 2019 final rule that prohibited states from making these types of payments.
    • CMS is currently seeking public comment on the proposed rule. Because this rule would affect many in the Medicaid HCBS workforce, which in turn has a direct and immediate impact on the quality of and access to services available to Medicaid beneficiaries, input from the aging and disability networks is crucial. Comments can be submitted online or by mail until September 28, 2021.


Last modified on 10/08/2021

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