Home and Community Based Medicaid Waiver Rules

Excerpts from full document and Disability Scoop

The Centers for Medicare & Medicaid Services (CMS), HHS:

Amendment:  Medicaid regulations to define and describe state plan section 1915(i) home and community-based services (HCBS) under the Social Security Act (the Act) amended by the Affordable Care Act. This rule offers states new flexibilities in providing necessary and appropriate services to elderly and disabled populations. This rule describes Medicaid coverage of the optional state plan benefit to furnish home and community based-services and draw federal matching funds. This rule also provides for a 5-year duration for certain demonstration projects or waivers at the discretion of the Secretary, when they provide medical assistance for individuals dually eligible for Medicaid and Medicare benefits, includes payment reassignment provisions because state Medicaid programs often operate as the primary or only payer for the class of practitioners that includes HCBS providers, and amends Medicaid regulations to provide home and community-based setting requirements related to the  Affordable Care Act for Community First Choice State plan option. This final rule also makes several important changes to the regulations implementing Medicaid 1915(c) HCBS waivers.

Disability Scoop reports that housing for those with disabilities will not only be judged by its location or physical characteristics but will also have to meet specific “outcome-oriented” criteria in order to qualify under Medicaid home and community-based services waivers. Home and community-based settings do not include a nursing facility, institution for mental diseases or an intermediate care facility for individuals with intellectual disabilities,” and homes “must exhibit specific qualities to be eligible sites for delivery of home and community-based services” under the new federal requirements. They must be integrated in and provide full access to the community and be places where individuals choose to live. Homes must offer personal rights to privacy and dignity and allow individuals to independently make choices about daily activities, their physical environment and who they interact with.

“People with disabilities and older adults have a right to live, work and participate in the greater community,” said Secretary of Health and Human Services Kathleen Sebelius. “Today’s announcement will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

States offering existing Medicaid waivers for home and community-based services must establish transition plans to meet the new requirements as soon as possible under the rule.