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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

Final Rule Grants States Flexibility in Medicaid Home- and Community-based Services

January 16, 2014 | Medicaid | Comments
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The Centers for Medicare and Medicaid Services released a final rule Friday that expands Medicaid payments for home- and community-based services and gives states more flexibility in administering their waiver programs. Currently, 47 states and the District of Columbia are using home- and community-based care under Medicaid waivers.

The final rule, which keeps intact most provisions of a proposed rule issued last year, outlines the details of how states may decide which settings count as “home- and community-based.” These include:

  • The setting is integrated in and supports full access to the greater community;
  • Is selected by the individual from among setting options;
  • Ensures individual rights of privacy, dignity and respect, and freedom from coercion and restraint;
  • Optimizes autonomy and independence in making life choices; and
  • Facilitates choice regarding services and who provides them.

The final rule also includes additional requirements for provider-owned or controlled home- and community-based residential settings. These requirements include:

  • The individual has a lease or other legally enforceable agreement providing similar protections;
  • The individual has privacy in their unit including lockable doors, choice of roommates and freedom to furnish or decorate the unit;
  • The individual controls his/her own schedule including access to food at any time;
  • The individual can have visitors at any time; and
  • The setting is physically accessible.

State officials have the flexibility to further define which providers qualify. These criteria must be met for providers to receive payments from CMS for home- and community-based services. Importantly for healthcare providers, they will also be used as the standard definition of home- and community-based services across other Medicaid programs such as 1115 and 1915(b) waivers.

The final rule also gives states some flexibility in how they pay for home- and community-based care. States will have a transition period of one year to put these changes into effect.

The home- and community-based services waiver was put into effect as a Medicaid option in 2005 and was expanded by the 2010 Affordable Care Act. The purpose of the waiver program is to allow seniors and persons with disabilities to receive services in their communities, rather than costly institutional settings. Click here to view a CMS fact sheet on the final rule.