The new federal home and community-based services (HCBS) regulations offer an opportunity for states and stakeholders to improve Medicaid long-term services and supports for older adults. At the state and national level, the transition process to comply with the regulations is initiating thoughtful discussions about what it means to provide quality, community-based care, in a variety of settings. Read More
In early 2014, after a lengthy public process, CMS finalized new rules that define the characteristics of a Home & Community-based Services (HCBS) setting. The new standards aim to improve HCBS quality and ensure individuals who receive Medicaid HCBS services can engage and fully participate in community life, better control and coordinate their care, and have opportunities to seek employment in competitive settings.
In response to persistent confusion and misinformation about the new HCBS settings rules, a group of national disability and aging organizations (including Justice in Aging) put together a Q&A written for advocates and the general public to explain the transition process and what the rules do and do not require.
States must submit state-wide transition plans to CMS before March 17, 2015 and must first provide the public opportunity to comment on these plans. You can find information on your state’s status at hcbsadvocacy.org. Justice In Aging has a number of resources on the new rule, available here.
In this July tool for consumers, NSCLC shares four tips regarding state transition plans for new Medicaid HCBS regulations. States now are beginning to release their transition plans to bring their Medicaid HCBS systems into compliance with the new federal regulations on community-based settings. It is essential that consumers and their representatives be prepared to evaluate those plans and advocate for improvements.
June 2014 — To assist government officials and stakeholders, Justice in Aging has written Just Like Home: An Advocate’s Guide for State Transitions Under the New Medicaid HCBS Rules. The guide provides analysis and recommendations for multiple aspects of the new regulations, including determining which settings are disqualified for HCBS, and enforcing consumer protections.
April 2014 — The National Senior Citizens Law Center (NSCLC) believes that home and community-based services (HCBS) should be provided as an option to every Medicaid beneficiary (consumer) who needs such services, allowing more seniors and persons with disabilities to live with dignity and independence in their homes. Under Medicaid law, HCBS funding exists to give consumers the ability to receive necessary long-term services and supports (LTSS) without moving into a nursing home or other healthcare institution. The value of the HCBS alternative would be destroyed or diluted if HCBS were provided in institution-like settings.
New federal Medicaid rules, for the first time, set standards to ensure that Medicaid-funded HCBS are provided in settings that are non-institutional in nature. These standards, which took effect in March 2014, apply to residential settings such as houses, apartments, and residential care facilities like assisted living facilities. The standards also apply to non-residential settings such as adult day care programs.
This guide provides consumers, advocates and other stakeholders with information regarding multiple facets of the new standards, including consumer rights in HCBS, and the guidelines for determining which settings are disqualified from HCBS reimbursement. This guide is based on the federal rules and subsequently issued guidance, and will be updated as further information becomes available.
Importantly, many details remain to be determined by individual states, subject to review and approval by the federal government. Stakeholder involvement and advocacy will be critical as state Medicaid programs transition through implementation of the new rules. Throughout the transition process, both the states and the federal Centers for Medicare and Medicaid Services (CMS) must accept and consider recommendations from consumers and other stakeholders.
The guide offers advocates a primer on the law that impacts Medicaid-funded home and community-based services. It highlights key resources and tools to use when advocating to expand and preserve Medicaid coverage of critical LTSS services.
A September 2010 NSCLC report, 10-Plus Years After the Olmstead Ruling: Progress, Problems, and Opportunities, calls on Congress and the states to give older adults and people with disabilities to expand the use of home and community based services and to deemphasize the institutionalization of our elders as the health care reform law suggests and encourages.
NSCLC Olmstead Report (Large Type)
Webinar Recording (73 MB Windows Media)