Robert King | March 22, 2019
The CMS offered new advice for state Medicaid directors to determine if assisted-living facilities, group homes and home-based care settings are meeting Medicaid funding requirements.
The agency released new guidance on Friday to state Medicaid directors implementing a 2014 rule on Home and Community Based Services, or HCBS. The guidance will help states determine whether a facility such as an assisted-living facility or group home isolates residents from participating in the larger community, which could determine whether the facility loses Medicaid funding.
Since the rule was released in 2014, there has been little definition on isolation and that has left state Medicaid directors flummoxed over whether facilities meet the HCBS standard.
“Isolation is a pretty subjective term and we have been asking for a while to have CMS give us some guidance on those places where people currently get service that may in fact not meet that new standard,” said Camille Dobson, deputy executive director of the National Association of States United for Aging and Disabilities, which represents state and territorial agencies on aging and disabilities.
Under the new guidance, a setting that is isolating individuals is defined as a facility that limits any opportunities for patients and residents to interact with the broader community. For example, an assisted living facility could lose Medicaid eligibility if it restricts a beneficiary’s choice in exploring activities outside of the facility.
The previous guidance could ding a facility for isolating patients based on what the building looks like, said Damon Terzaghi, senior director of Medicaid policy and planning at the National Association of States United for Aging and Disabilities.
“It is a very good step forward that removes some of the onerous and frankly nonsensical requirements that were in place,” he said.
The guidance also helps clarify the “heightened scrutiny” process that allows a state to affirm to the CMS that that a setting meets the HCBS criteria and can get Medicaid funding and aims to loosen oversight of private homes.
“The implementing guidance issued under the prior administration was simply too prescriptive and unfairly singled out certain settings, causing unnecessary anxiety for many beneficiaries, families and providers,” CMS Administrator Seema Verma said in a statement.
This is the latest attempt by the CMS to relax Obama-era rules on Medicaid home care. Back in May 2017, the agency delayed implementation of the 2014 rule.
States had until March 17, 2019, to implement the 2014 rule. However, the CMS gave states another three years to implement the rule.
Source: Modern Healthcare
https://www.modernhealthcare.com/government/cms-clears-up-home-and-community-based-care-requirements