CMS seeks input on home- and community-based services

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The Centers for Medicare & Medicaid Services is seeking input on reforms and policy options it can consider to accelerate the provision of home- and community-based services to Medicaid beneficiaries. The request for information is scheduled to be published Wednesday in the Federal Register and is available in PDF now.

The request comes as many assisted living operators are concerned that they will be excluded from providing such services to older adults through Medicaid waivers. States are in the process of devising plans to implement a 2014 final rule from CMS, scheduled to go into effect in March 2019, that established new reimbursement criteria related to HCBS. Under the rule, certain settings are presumed ineligible for the Medicaid waiver program — including settings located in buildings in which inpatient institutional treatment is provided, settings in buildings on the grounds of or adjacent to a public institution, or settings that isolate individuals from the broader community — unless they meet a heightened standard of proof. (See the links below, under Related Articles, for additional information.)

Ideas shared in response to the new request for information should take into account issues affecting beneficiary choice and control, program integrity, rate-setting, quality infrastructure and workforce issues, according to the federal agency.

CMS is seeking input on these questions specifically:

  • What are the additional reforms that CMS can take to accelerate the progress of access to HCBS and achieve an appropriate balance of HCBS and institutional services in the Medicaid long-term services and supports system to meet the needs and preferences of beneficiaries?
  • What actions can CMS take, independently or in partnership with states and stakeholders, to ensure quality of HCBS, including beneficiary health and safety?
  • What program integrity safeguards should states have in place to ensure beneficiary safety and reduce fraud, waste and abuse in HCBS?
  • What are specific steps CMS could take to strengthen the HCBS workforce, including establishing requirements, standards or procedures to ensure rates paid to care providers are sufficient to attract enough workers to meet the service needs of beneficiaries and that wages supported by those rates are sufficient to attract enough qualified caregivers?

People have until Jan. 9 to respond to CMS. For more information, see the request for information in the Federal Register.

More than 3.2 million Medicaid beneficiaries received HCBS in calendar year 2012, according to CMS, including 764,487 people who received home health state plan services, 944,507 who received personal care state plan services and almost 1.5 million were served through section 1915(c) waivers. By 2014, the agency said, 53% of the $152 billion spent nationally on Medicaid LTSS was for HCBS. HCBS spending for individuals with intellectual and/or developmental disabilities represented approximately three-fourths of Medicaid LTSS spending in 2014, whereas HCBS spending percentage for older adults, individuals with physical disabilities and individuals with serious mental illness/serious emotional disturbances accounted for  41% of total LTSS spending, according to CMS.

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