Montana Medicaid Access Rule (Home)
About the Access Rule
In April 2024, the Centers for Medicare & Medicaid Services (CMS) issued the Ensuring Access to Medicaid Services Rule (Access Rule) to improve health care access, service quality, and health outcomes for Medicaid beneficiaries. This regulation applies across fee-for-service (FFS) and managed care delivery systems, including Home and Community-Based Services (HCBS) provided through those delivery systems.
The Department of Public Health and Human Services (DPHHS) is working to implement federal Medicaid Access Rule requirements.
The federal CMS Medicaid Access Rule aims to expand and simplify how members receive services and supports. The regulation focuses on improving quality, increasing transparency, and ensuring Medicaid members and families have a stronger voice in how their care is delivered. For Montana, this rule means the state will make updates to policies, systems, reporting, and public engagement processes over the next several years to strengthen Medicaid services.
Members
Members may see:
- More opportunities to provide feedback on Medicaid services
- Stronger grievance and issue resolution processes
- Improved person-centered service planning
- Greater transparency about available services and supports
- Better access to information about Medicaid programs and quality
Providers
Providers may see:
- Updated requirements for documentation, planning, and reporting
- New training and technical assistance opportunities
- Changes to quality reporting and performance expectations
- Increased communication from DPHHS about implementation timelines and requirements
Advocates and Partners
Advocates and partners may have:
- More opportunities to participate in advisory groups and public meetings
- Access to implementation updates, data, and policy drafts
- Additional opportunities to provide feedback on proposed changes
Access Rule Requirements
DPHHS is currently working on multiple Access Rule requirements, including:
- Strengthening stakeholder engagement through advisory committees and public input opportunities
- Improving grievance systems so Medicaid members can raise concerns and receive support
- Updating person-centered planning processes for HCBS programs
- Preparing for HCBS quality measure reporting
- Improving transparency and public reporting
Many of these changes will occur in phases over several years as federal implementation deadlines approach.
DPHHS is committed to implementing the Access Rule in a thoughtful and transparent way that reflects Montana’s unique needs, including those of rural communities, providers, tribal partners, Medicaid members, and families. Stakeholder feedback will play an important role as Montana develops and implements these changes.
For updates, meeting information, timelines, and resources, please visit this webpage regularly as new materials become available. You may also visit our Frequently Asked Questions page to learn more about the Access Rule.
Stakeholder Engagement
Beneficiary Advisory Council (BAC)
The BAC is an advisory group of Medicaid beneficiaries, their families, and caregivers. The council provides a dedicated forum for individuals to give DPHHS direct feedback on Medicaid access and program experiences.
Medicaid Advisory Committee (MAC)/Montana Health Coalition
The Medicaid Advisory Committee (MAC) is an advisory group of providers, stakeholders, and community representatives established to meet federal requirements for Medicaid oversight. The committee provides a dedicated forum for advising the Department director, state Medicaid director, and Medicaid administrators on health and medical care services.
Rate Reporting
The Access Rule requires assurance from the State that payment rates are adequate to ensure enough direct care workers are employed to meet the needs of members and provide access to services in the amount, duration, and scope specified in the member’s person-centered service plan.
Additional Resources
Contact Information
For questions about the Access Rule, please contact Savannah Olsen at savannah.olsen@mt.gov
