THOUSANDS MORE MEDICAID ENROLLEES COULD GET HOME AND COMMUNITY-BASED

CARE UNDER NEW RULE

DRA GIVES STATES NEW OPTIONS FOR CARE

Thousands of Medicaid beneficiaries who were previously limited to receiving care in an institutional setting may now be given the option to receive that care in their homes and communities, under a proposed rule  published today by the Centers for Medicare & Medicaid Services (CMS).

The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide home-and-community based services (HCBS) to Medicaid beneficiaries without applying for a demonstration waiver.  The proposed rule provides guidance to states on how to implement this provision of the DRA.

For further information regarding today’s announcement please visit the CMS website at one of the following links.

Link to Press Release-http://www.cms.hhs.gov/apps/media/press_releases.asp

Link to Medicaid Regulations Page-http://www.cms.hhs.gov/MedicaidGenInfo/08_Medicaidregulations.asp

Direct Link to NPRM (PDF File)-http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2249P.pdf

New Rules from CMS take a bite out of the

institutional bias...

This proposed rule allows states -- which apply-- much greater flexibility

to provide and focus on community long term services and supports; but states

must apply and be approved.  The proposed rule makes important changes

however it doesn't end the insitutional bias as it is for people with incomes at or

below 150% of poverty, less than the 3X SSI of most nursing home rules, and

allows States to put caps on the service covered.  It is however a good step

in the right direction...

The proposed rule will be published in the Federal Register on April 4, 2008,

and will have a public comment period through June 3, 2008.  Go to

http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2249P.pdf  to view the

complete proposed rule.

Centers for Medicare & Medicaid Services (CMS)

Press Releases

http://www.cms.hhs.gov/apps/media/press/release.asp?Counter=3018&intNumPerPa

Details for: THOUSANDS MORE MEDICAID ENROLLEES COULD GET HOME AND

COMMUNITY-BASED CARE UNDER NEW RULE

   For Immediate Release: Monday, March 31, 2008

      Contact: CMS Office of Public Affairs

      202-690-6145

THOUSANDS MORE MEDICAID ENROLLEES COULD GET HOME AND COMMUNITY-BASED CARE

UNDER NEW RULE DRA GIVES STATES NEW OPTIONS FOR CARE

Thousands of Medicaid beneficiaries who were previously limited to receiving

care in an institutional setting may now be given the option to receive that

care in their homes and communities, under a proposed rule  published today

by the Centers for Medicare & Medicaid Services (CMS).

The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide

home-and-community based services (HCBS) to Medicaid beneficiaries without

applying for a demonstration waiver.  The proposed rule provides guidance to

states on how to implement this provision of the DRA.

Under this option, states will now be able to set their own eligibility or

needs-based criteria for providing HCBS.  Previously, to qualify for

assistance with personal care, home health care or other services in the

home or community setting, beneficiaries were required to be at imminent risk of

institutionalization.  The DRA provision eliminates this requirement and

allows states to cover Medicaid recipients who have incomes no greater than

150 percent of the federal poverty level, or $15,600 per individual in 2008,

and who satisfy the needs-based criteria.

"Thousands more Medicaid beneficiaries may now be able to opt for needed

long-term support services in their homes rather than institutions," said

CMS Acting Administrator Kerry Weems. "Breaking the historic link between

long-term care and institutions will level the playing field and give

beneficiaries new choices for how they receive care."

The proposed rule emphasizes "person centered" care, giving individuals an

active role in developing their care plans, and the "self-direction" option

in which states can allow individuals to take charge of their own services.

The services states may make available under this benefit include case management,

homemaker, home health aide, personal care, adult day health, habilitation,

and respite care.  The DRA also allows states to provide special services to

individuals with chronic mental illness, including day treatment or other

partial hospitalization, psychosocial rehabilitation, and clinic services.

Under the proposed rule, states would no longer have to apply for a waiver

to provide HCBS to Medicaid beneficiaries.  Under the DRA, states only need an

approved state plan amendment (SPA) satisfying the DRA criteria.  Once

approved by CMS, the SPA does not need to be renewed nor is it subject to

some of the same requirements of waivers such as budget neutrality.

Since the DRA made the HCBS option available beginning in January 2007, CMS

has provided technical assistance to states wishing to move forward prior to

publication of the proposed rule.  One state, Iowa , has since been granted

an HCBS SPA.  Three additional states, Colorado , Nevada , and Georgia , have

requests pending under CMS review.

"We anticipate states will be eager to take advantage of this new

flexibility," Weems said. "The home and community-based services option is a

win/win opportunity, giving beneficiaries more control over their care and

allowing states to spend Medicaid resources more efficiently."

The proposed rule will be published in the Federal Register on April 4,

2008, and will have a public comment period through June 3, 2008.  Go to

http://www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2249P.pdf  to view the

complete proposed rule.

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