The federal “Access Rule” aims to improve access to care, quality and health outcomes, and better address health equity issues in Medicaid home and community-based services (HCBS). It took effect July 9, 2024, and requires some changes over several years. For people who receive regional center services, some of the changes will include:
- How complaints are handled
- How health and safety incidents are reported and addressed
- Strengthening the direct support professional workforce
What’s changing?
Some of the major changes include:
Standardized Incident Management
To make statewide reporting and monitoring more consistent, HCBS programs will use the same definitions for health and safety incidents (also known as “special incident reports” or “SIRs”) and their resolutions. This will:
- improve how incidents are resolved and investigated across programs
- improve collaboration with other investigative entities, including Social Services, Child and Adult Protective Services, and law enforcement
- Increase the minimum performance standards from 86% to 90%. This means that at least 90% of these incidents must be reported in a timely manner.
Simplified Grievance System
There are several existing processes for filing a complaint. This creates confusion for individuals and their families. Because of the federal Access Rule, starting February 1, 2027, there will be a simplified way track grievances, including rights violations, and citizen complaints. Grievances themselves are new under the Access Rule. Grievances may involve concerns or dissatisfaction with actions taken by a regional center, service provider, or state-operated facility related to individual rights, person-centered planning, or whether residential settings meet Home and Community-Based Services program requirements.
Each grievance will be assigned to the correct regional center for resolution, and the Department will review certain resolutions. Find more information on these changes on the Grievance web page.
These changes do NOT affect the following processes:
- Lanterman Act Service and Eligibility appeals regarding eligibility, and services and how much of them are provided.
- Whistleblower complaints, regarding certain inappropriate activity
- Early Start complaints, due process mediation, and appeals (see the “Early Start (Children 0-3)” tab on this page)
Find more information on these changes on the Consumer Rights, Appeals & Complaints web page.
Pay for Direct Service Providers (DSP)
By 2030, providers of certain services will be required to spend at least 80% of the payment they receive on pay for the workers who provide those services. These services include homemaker, home health aide, and personal care services.
Payment Rate Transparency
One change you can already see on our Access Rule webpage is that more information is available under the Payment Rates tab. There you’ll find the Department and Medi-Cal rates, plus hourly rates for personal care, home health aide, homemaker, and habilitation services.
Reporting Requirements
Over the next few years, the Department will post various HCBS reports online. These will include reports related to HCBS access, incidents, grievances, and DSP compensation.
Where can I get more information?
Here is a dedicated webpage with all Access Rule information, including required publications, regulatory information, and ongoing updates.