LeadingAge NY Joins LeadingAge in Call With CMS on HCBS Settings Rule
LeadingAge New York has been following and reporting on the developments regarding the federal home and community based settings rule over the past few years. The Centers for Medicare and Medicaid Services (CMS) has been issuing guidance since the rule was promulgated, to aid the states in coming into compliance. LeadingAge NY has had concerns and questions about the guidance, including the most recent Question and Answer document, regarding how CMS regards new construction of settings that includes services that fall under the HCBS rule. Specifically, we were concerned that CMS's guidance discourages the development of new assisted living and Adult Day Health Care (ADHC) services co-located in or on the grounds of a nursing home. Click here for background on this issue. LeadingAge NY sent CMS a letter outlining our concerns about the implication of that guidance for our members and the people they serve.
Last week, LeadingAge NY and the ADHC Council, along with other state affiliates and our national LeadingAge association representatives, met with CMS by phone to further discuss the issue. We shared with CMS our concerns that if implementation goes beyond the rule, limiting or prohibiting the use of co-located adult day programs and assisted living in or on the grounds of a nursing home, there could be unintended consequences that will result the narrowing of home and community services choices for the Medicaid-eligible elderly population. We also noted that seniors often prefer settings in which there are different levels of care, to ease transitions or allow a couple to remain together despite different care needs. Lastly, we discussed the efficiencies of co-located settings, enabling the provision of more services at a lesser cost.
CMS highlighted the importance of person-centered care and promotion of Home and Community Based Services (HCBS) settings that are more integrated with the larger community. They feel that HCBS services co-located with nursing home services have a higher probability of providing services in a more institutional way; thus heightened scrutiny process, which would take a closer look at the nature of the services provided. They also noted that this rule is essentially a compromise position; they received a lot of public comment on the rule as it was in development, and many of those who commented wanted a more aggressive position on these issues. LeadingAge NY and LeadingAge advocated at every opportunity while the rule was in development; however, we fear that given the complexity of the rule, CMS may not have heard from Medicaid-eligible elderly consumers.
In New York, the Department of Health (DOH) has been working with other state agencies on an updated transition plan to submit to CMS for approval. The plan will be made available for public comment, likely in July. Given the importance of public input in this process, we will review the plan carefully and will encourage members to provide comment. DOH will soon be issuing an assessment for assisted living programs to conduct to determine their current level of compliance with the requirements. It is important to note that the state has time to come into compliance with the HCBS settings aspect of the federal rule; it is not expected that all settings will necessarily meet all of the requirements at this time. It should also be noted that only one state has received CMS approval of their transition plan thus far.
Ultimately, we have several follow up questions for CMS to gain greater clarification on their position as it relates to our members. We are also in ongoing conversations with DOH about the implementation and transition plan. We will report to the membership as we learn more information, and we welcome any questions.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828 or Anne Hill, ahill@leadingageny.org, 518-867-8383