Federal Advocacy Call to Action: Urge HHS to Include DSPs in New Medicaid Access Rule to Assure Better, More Equitable Wages

Direct Support Professionals!! 

PLEASE COMPLETE THE FOLLOWING ADVOCACY ACTION NO LATER THAN JULY 3, 2023

What is the Advocacy Action?

The U.S. Department of Health and Human Services (HHS) recently released a proposed regulation, officially titled, “Medicaid Program: Ensuring Access to Medicaid Services”, also known as “The Access Rule”. In February 2022, CMS issued a request for information (RFI) on access to care and coverage for people enrolled in Medicaid and CHIP, and in December 2022, CMS summarized the responses. The access proposed rule marks the next step in their regulatory process, and it includes major changes related to the provision of Medicaid-funded Home and Community-Based Services (HCBS). The National Alliance for Direct Support Professionals is urging all DSPs to engage in the public comment process, and urge HHS to include DSPs in wage protections outlined in the Access Rule.

Background On The Access Rule & Its Exclusion Of DSPS In Wage Protections

The proposed rule would make a series of positive changes to HCBS, including efforts to make care provided more person-centered and equitable. The proposed rule would also establish a new grievance system for HCBS and a new “incident management” system, following alarming reports of widespread and serious gaps in basic health and safety practices. States would be required to routinely evaluate HCBS payment adequacy, aiming to address workforce shortage issues, and to report on standardized quality measures.

One of the most important provisions of the Access Rule is that it would establish additional transparency and interested party engagement requirements for setting Medicaid payment rates for home and community-based services (HCBS), and includes a requirement that at least 80 percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit). The government wants state Medicaid systems and providers to demonstrate that increases in federal funding are leading to increased wages for front-line direct care workers. For HCBS, the state would be required to disclose: the payment amounts on an average, hourly payment rate basis; the number of claims paid; and the number of services rendered. The state would also be required to form an “interested parties” advisory group to advise and consult with the Medicaid agency on current and proposed rates for direct care workers.

Unfortunately, DSPs were left out of this provision, which means that the system will continue to have a lot of ambiguity about how rates are set and will not ensure that DSPs also receive higher, more equitable wages when HCBS rates increase. That is why NADSP is reaching out asking all DSPs to take a few moments and express your concerns to HHS directly!

Why Your Voice Is Critical To Change!

NADSP wants as many DSPs to weigh in directly with HHS as possible, because we believe that HHS will expand the wage protections to include DSPs but only if they hear from DSPs directly. We believe this is a once-in-a-decade opportunity to get these wage protections in place for DSPs, and if we don’t seize the moment now, we may not have this opportunity again anytime soon.

What We Need You To Do:

The federal government is asking for the public to submit comments about the Access Rule online.  It is a very simple process that should take 10 minutes or less to complete. We have included each step below for how you can submit your own comments, as well as some suggested talking points.

1. Go to the Access Rule Public Comments Section at: https://www.regulations.gov/commenton/CMS-2023-0070-0001.
2. In the “Comments” Section, tell them you are a DSP or an ally of a DSP, and you are concerned about the exclusion of DSPs from the HCBS wage requirements for direct care workers. You can use the following template to draft your own comments – feel free to add any other details you wish about the types of work you do and what your work means to the people you support.

“My name is XXXXXX and I am a direct support professional (DSP) who currently works XX a week on average supporting an individual who lives with an intellectual and developmental disability who meets nursing home or institutional level of care. In my work, I provide direct care to support this individual in meeting critical activities and intermediate activities of daily living so that they can live, work and thrive in the community. I understand that the new Medicaid Access Rule establishes new requirements for setting Medicaid payment rates for home and community-based services (HCBS), and includes a requirement that at least 80 percent of Medicaid payments for personal care, homemaker, and home health aide services be spent on compensation for direct care workers (as opposed to administrative overhead or profit). I am very concerned that DSPs were left out of this provision, as we are responsible for similar tasks of these other professionals plus many other tasks requiring additional skills.  Right now, there is no transparency in how rates for HCBS are established, and I and my colleagues who are direct support professionals deserve the same wage protections, transparency, and support as these other direct care workers.  I urge HHS to include direct support professionals under this requirement in the final Access Rule, and support the estimated 1 million DSPs that are providing critical HCBS to people living with intellectual and developmental disabilities in the United States.”

Under the Question:  “What is this Comment About?”, use the drop down menu to find “Health Care Professional/Association – Other Practitioner” and choose this option.

Add your email address where it is requested.

Click “Individual” at the bottom of the page.

Click the reCAPTCHA and check “I am not a Robot.” Press Submit.

Confirm receipt by checking your email in-box where you should receive a submission confirmation.

Email communications@nadsp.org at the NADSP and let us know that you completed this advocacy request so we can keep track of how many DSPs across the country have communicated with HHS.

Comments are due on July 3, 2023, so there’s no time to waste!  HHS needs to hear from the voices of DSPs about the importance of including DSPs in the new wage protection rules so that DSPs will be paid equitably and fairly in the future as Medicaid rates increase.