CMS Eases Use of Medicaid Funds for Home-, Community-Based Care

On Friday, CMS published a final rule under the Affordable Care Act intended to encourage states to use Medicaid funds to provide home- and community-based care for older U.S. residents and those who have physical and mental disabilities, Modern Healthcare reports.

According to Modern Healthcare, states previously had to apply for a waiver to use Medicaid funds for home- and community-based care programs (Dickson, Modern Healthcare, 1/10). Under the new rule, states can:

• Run waiver and demonstration programs for five years, pending CMS approval, for people eligible for both Medicaid and Medicare;
• Combine up to three groups of patients whom the state wants to get a home- or community-based care waiver; and
• Apply for exceptions in payment policies that typically require the state to pay only individual practitioners who provided a service.

However, states are not allowed to cap the number of people eligible for home- or community-based care programs.

The rule also details the requirements to qualify as a home- or community-based provider. The rule requires that entities provide patients with:  

• A setting that is integrated with the community;
• The freedom to seek employment and work in integrated settings, engage in community life, control their personal resources and receive community services;
• Several options and providers for medical care; and
• Privacy rights, eviction rights and scheduling freedom under certain guidelines for those living in residential community programs.

Under the rule, states have to further define which providers qualify, subject to federal review and approval. In addition, the rule states that individuals who are transitioning from nursing homes, hospitals and intermediate care facilities for patients with mental illnesses -- which typically are not considered home- and community-based care providers -- can qualify for such care. Moreover, assisted nursing facilities that allow residents independence would not automatically qualify as nursing homes under the rule (Adams, CQ HealthBeat, 1/10).

However, the rule disqualifies providers that are located too close to a nursing home from qualifying as a home- or community-based care provider (Modern Healthcare, 1/10).

The rule gives states one year to implement the changes (CQ HealthBeat, 1/10). It is expected to cost $150 million in 2014 (Devaney, "RegWatch," The Hill, 1/10).

William Dombi, executive director of the National Council on Medicaid Home Care, praised the rule, saying it would cut back on how much time agencies have to spend navigating bureaucratic red tape and allow them to focus on providing care (Modern Healthcare, 1/10). 

Similarly, National Association of Medicaid Directors Matt Salo praised the administration for providing an adequate transition time for states in the rule. "[W]e were pleased that the administration heeded our calls for an extended transition period" that will give states enough time "to make extensive reforms to their long-term services and supports delivery system models," as well as time "to work with providers and consumers" to ensure a "smooth transition[n]," Salo said.

Separately, Senate Health, Education, Labor and Pensions Committee Chair Tom Harkin (D-Iowa) said the rule "is a strong step forward toward fully realizing the promise of the Americans with Disabilities Act" (CQ HealthBeat, 1/10).