Access Rule Compliance

Some of the terms used on this webpage may not be familiar to everyone. We have explained what these terms mean as they apply to the information on this webpage. 

• Advisory Committees: Groups of people who used to have, still have or work with Medicaid. These groups are run by the state. These groups work to guide and improve Medicaid programs and services. North Dakota has two groups. The first group is the Medicaid Advisory Committee (MAC). The second group is the Beneficiary Advisory Committee (BAC). These groups have members who meet federal requirements to join. They share the views and opinions of beneficiaries, providers and other stakeholders. The views and opinions of these groups are considered when making decisions.
• Authorized Representative: A responsible adult who can act on behalf of the person receiving services.
• Beneficiary/Recipient: An individual who is receiving or has received benefits under economic assistance or Medicaid programs.
• Centers for Medicare & Medicaid Services (CMS): A federal agency within the Department of Health and Human Services that administers the nation's major healthcare programs, including Medicare and Medicaid.
• Complaint: A complaint is a report about a Medicaid provider when something may be wrong.
• Fee For Service (FFS): A system of health insurance payment in which the enrolled healthcare provider is paid a fee for each service given.
• Grievance: A grievance is a concern raised by a member or their legal representative about person-centered planning or services.
• Home and Community-Based Services (HCBS): A variety of person-centered services for members with functional limitations. HCBS aims to keep members living independently by helping with activities of daily living in the member’s home and community. These services are part of the Medicaid program.
• Payment Adequacy and Rates: These measures support fair pay for direct care workers and service providers. This helps keep the workforce stable. A stable workforce makes sure members can get quality care and services when and where they are needed.
• Person Centered Service Plan (PCSP): A plan that makes sure an individual gets the program services and supports they need. This plan makes sure the individual reaches their goals and gets their desired outcomes. The plan is made with the individual instead of for them. It focuses on their goals, their choices and the support they need to live the life they want. 
• Provider: A physician; nurse practitioner; registered nurse; licensed practical nurse; nurse aide; private or not-for-profit agency; case manager; state Medicaid agency or state sister agency; Medicaid durable medical equipment (DME) supplier; home modification business or other providers of HCBS.
• Incident Management System: Identifies, reports, triages, investigates, resolves, tracks and trends critical incidents.
• Waitlist and Access Measures: A tracking system that shows how quickly services and supports are approved. This system tracks service start times and wait times. It reports service use to improved access to services.
• Website Transparency: A rule that makes sure websites share honest information in a way that is easy to find and move through. Websites should offer information to the public about HCBS program performance. They should include ways to measure quality, report incidents and payment rates. Websites should also share other data that shows the program is following CMS rules.
• Quality Measure Set: These tools show how well Medicaid services are working. These tools track issues and measure service quality. This process helps Medicaid find ways to improve services and outcomes.

The Access Rule makes sure each state has a grievance process. 

A grievance is a concern. A grievance can be raised by either the person getting the services or their legal representative. The grievance should be about the individual’s person-centered plan or services. The grievance may be about the planning process, the person-centered plan or living arrangements. This process makes sure concerns are heard, reviewed and resolved. People can file a grievance about:

• The Person-Centered Service Planning process.
• Home and Community-Based Services (HCBS) settings requirements, such as people making their own choices, being treated with dignity and respect, having rights, and being part of their community.
• Transition services to help people move from one part of life to another or plan for what’s next.
• How your provider delivered services from your person-centered plan.

Program contact information is found in the Submit a Grievance section of this webpage.

Access Rule Requirements

States must have a formal process for individuals to file a grievance about services and ensure those issues are addressed.

Review the Code of Federal Regulations 42 CFR 441.301(c)(7). This rule is not in full effect until Dec. 31, 2027. More information coming soon.

Some of our programs define a complaint differently than a grievance. 

A complaint is a report about a Medicaid provider. Anyone can file a complaint if they think there is a problem with a Medicaid provider. This report should be made when something may be wrong. This could include poor care, health or safety concerns, incorrect billing, possible fraud, waste, abuse or not following required rules.

Program contact information is found in the Submit a Grievance section of this webpage.

Review the Code of Federal Regulations 42 CFR 441.302(a)(6). This rule is not in full effect until July 9, 2027. More information coming soon.

Our website should share how to report problems, get help and share information about HCBS quality, performance and rates. Our website should make information easy to find and understand. We should use plain language writing, many languages and different formats to make our website better.

Help Us Improve Our Process

We want your grievance reporting experience to be easy and meaningful. If you have a suggestion on how we can improve our grievance reporting process, please email your thoughts and suggestions to mmccloud@nd.gov. 

Review the Code of Federal Regulations 42 CFR 441.313(a). This rule is not in full effect until July 9, 2027. More information coming soon.

Review the Code of Federal Regulations 42 CFR 441.301(c). This rule is not in full effect until July 9, 2027. More information coming soon.

Review the Code of Federal Regulations 42 CFR 441.311(d). This rule is not in full effect until July 9, 2027. More information coming soon.

The new Access Rule says that every state must have two groups to help the state understand how to deliver Medicaid programs and services better. One group is a Medicaid Advisory Committee (MAC). The other group is a Beneficiary Advisory Committee (BAC). These groups have federal rules for who can be a member of the groups and how they should apply to be part of them.

The Medicaid Advisory Council (MAC) helps the state understand how to deliver Medicaid programs and services better. Each state that offers Medicaid has a MAC. North Dakota’s MAC is called the Medicaid Medical Advisory Committee (MMAC). Our MMAC makes sure members can get Home and Community-Based Services (HCBS). The MAC also focuses on the quality of HCBS being offered. 

The MMAC’s must:

• Give advice on Medicaid policies and services.
• Have at least 25% of its members be from the Beneficiary Advisory Council (BAC).
• Offer at least two public meetings where public comments can be made.
• Makes sure MMAC meeting agendas, minutes, bylaws and list of members are available to the public.
• Get State support to organize and hold activities.

The Beneficiary Advisory Council (BAC) helps the state improve Medicaid programs and services. Each state must have a BAC. North Dakota’s BAC is called the Medicaid Member Engagement Committee (MMEC). MMEC members must be current or recent Medicaid members or family caregivers to current members.

The MMEC must:

• Advise the state on home and community-based services (HCBS) by sharing feedback and personal experiences.
• Have some members serve on the Medicaid Medical Advisory Committee (MMAC). These members will further guide the state on Medicaid policies and program decisions.
• Be transparent and accountable. One way this should be done is through holding public engagement activities.
• Participate in yearly reporting on what the MMEC did through the year.

 Program contact information is found in the Submit a Grievance section of this webpage.

Access Rule Requirements

The MAC and BAC provisions of the Access Rule are designed to enhance the quality of care and improve health outcomes for Medicaid beneficiaries, particularly in-home and community-based services (HCBS).

The Interested Parties Advisory Group (IPAG) requirement, established under the Medicaid Access Rule, instructs states to establish a work group to advise on the adequacy of rates for direct care workers who provide home and community-based services (HCBS) for people with disabilities. States must establish and begin convening IPAGs by July 2026. By centering the experiences and needs of people with disabilities, states can also support more transparent and responsive rate-setting processes. In doing so, they can help secure adequate wages and develop strategies to strengthen the direct care workforce that supports people who use home and community-based services.

Access Further Information

• MAC/Medicaid Medical Advisory Committee (MMAC) webpage
• BAC/Medicaid Member Engagement Committee (MMEC) webpage

Review the Code of Federal Regulations 42 CFR 431.12.

Review the Code of Federal Regulations 42 CFR 441.312(d). This rule is not in full effect until July 2028. More information coming soon.

The Access Rule shows how Medicaid uses funding. It also makes sure caregivers and staff are paid fairly. This rule supports a stable workforce. A stable workforce helps Medicaid members get the care and services they need. It also makes sure members can get their services when and where they need them.

Direct care workers include direct service staff, nurses, nurse staff, CNAs, personal care staff, home health staff and others. These workers help members live, work and connect with their communities. Workers help members with daily activities, behavioral support, employment support and community connection.

This table shows how much Medicaid Fee for Service (FFS) providers are paid. Pay rates have been averaged across different programs. The programs include Adult and Aging Services, Developmental Disabilities, Autism, Medically Fragile and 1915(i) Home and Community-Based Services (HCBS) programs. We want to promote transparency with our members, providers, stakeholders and the public. We want them to know how much our FFS providers are being paid. Our payment information is reviewed and updated every two years. This helps us make sure our information is current. It also helps us share the most recent, approved Medicaid fee schedule.

Medicaid Fee for Service Rates

Daily rates are not factored into the rates displayed in this table.

Access Rule Requirements

• States must ensure payment rates are sufficient to support a stable, qualified direct care workforce and monitor how payments translate into worker wages and benefits.(vii). 
• States must collect and report data on access to HCBS, including wait times, service availability and unmet need.
• States must ensure and report that services are planned based on individual needs, preferences and goals, with documentation of person-centered planning processes.
• States must track, investigate and remediate critical incidents (e.g., abuse, neglect, exploitation) to protect participant health and safety.
• States must use standardized quality measures to monitor and improve HCBS program performance.

Review the Code of Federal Regulations 42 CFR 441.302(k).

Review payment rates.