Specifically, the
Final Rule discusses HCBS under §1915(i) of the Social Security Act (“the
Act”), and describes the Medicaid optional state plan benefit to furnish HCBS
and draw federal matching funds, without the State having to obtain a
waiver. Also significant, the Final
Rule defines community-based settings as locations where individuals have full
access to greater community, opportunities to seek employment and control
personal resources, along with additional rights. Individuals must have privacy
in their sleeping or living quarters, units that have lockable entrance doors
and the choice of whether to have a roommate, among others. However, the Final Rule disqualifies homes
that are deemed too close to a nursing home, because the home is likely to be
operated in a similar manner to the nursing home (the home is located in a
building that is also a publicly or privately operated facility that provides
inpatient institutional treatment, or in a building on the grounds of, or immediately
adjacent to a setting that has the effect of isolating individuals)
The Final Rule also:
• Provides a 5-year demonstration
project/waiver for States that provide medical assistance for individuals
dually eligible for Medicaid and Medicare benefits.
• Provides payment reassignment
provisions because State Medicaid programs are often the primary or only
payment for HCBS providers.
• Amends Medicaid regulations to
provide HCBS requirements for the Community First Choice State plan option
(under §1915(k) of the Act)
• Provides a few other changes to
waivers under §1915(c) of the Act.
· Allows States to combine the existing
three waiver targeting groups identified in 42 CFR §441.301
· Implements requirements regarding
person-centered services plans
· Clarifies timing of State amendments
to current HCBS waiver programs and services rates
· Provides additional strategies to
ensure state compliance with §1915(c) of the Act
· Establishes HCBS requirements and
provides a transition/phase-in period for current §1915(c) waivers to
demonstrate compliance.
For questions regarding this Final Rule of
HCBS, please contact Meghan McNab at mmcnab@kdlegal.com
or Kristen Gentry at kgentry@kdlegal.com.