CMS Issues Final Rule on HCBS Waivers and Settings

The Centers for Medicare and Medicaid Services (CMS) have been working for approximately five years on regulations related to home and community-based waivers. LeadingAge New York, as well as LeadingAge, have been actively working on this issue to ensure options for seniors and our members. Last week, CMS announced the final rule which includes the following:

Home and Community-Based Settings Requirements: Defines the characteristics of home and community-based settings for the purposes of receiving home and community-based waiver services. LeadingAge New York was extremely concerned about the proposed rule because the standards would be applied to those enrolled in Managed Long Term Care (MLTC), as well as 1915(c) and (i) waivers, and would have excluded many of our members as appropriate settings. We are pleased to report that the final rule eliminated much of the problematic language. Click here for a CMS overview of this issue;
Person-Centered Planning: Describes the minimum requirements for person-centered plans;
1915 (c) Waivers: Provides states the option to combine multiple populations under one waiver, in addition to the above;
Section 1915 (i): Home and Community-Based State Plan Option- provides states new flexibilities to offer expanded HCBS services to targeted populations; and,
Five-Year Period for Certain Demonstration Projects and Waivers: Allows states to use a five-year renewal cycle to align current waivers that serve individuals eligible for both Medicare and Medicaid.

Aspects of the home and community-based settings characteristics in the proposed rule were evident in the Special Terms and Conditions (STCs) for the state’s agreement with the federal government regarding MLTC, as well as the Opportunity for Development (OFD) for transitional adult homes to access Assisted Living Program (ALP) beds. Given the change in language in the final rule, we are exploring the implications for MLTCs, FIDA and the ALP OFDs. We will also be working with the Department of Health on the interpretation of language in the federal rule, as it may influence regulations or practices for providers in New York. We will keep members apprised of these issues.

The text of the full rule, as well as summaries of the key provisions, are available here. CMS is conducting education on the final rule on Jan. 23, 2014 from 1-3 p.m. EST. The webinar will be repeated on Jan. 30 from 1-3 p.m. EST. Registration information will be available on this site shortly.

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828 or Cheryl Udell, cudell@leadingageny.org, 518-867-8871