CMS Issues Compliance Toolkit Regarding HCBS Settings Rule

The Centers for Medicare and Medicaid Services (CMS) have published further guidance on the Home and Community-Based Services (HCBS) final rule adopted in January of this year. The rule imposes a variety of standards on HCBS settings in order to qualify for Medicaid reimbursement under federal HCBS waivers. CMS has indicated that such standards will, in the future, apply to 1115 waivers, such as New York's mandatory managed care waiver.  LeadingAge NY has been following this issue closely to understand what impact the rule will have on providers in a managed care environment.

The rule presumes that certain settings have institutional qualities and thus do not meet the rule’s requirements for home and community-based settings. These settings include entities on a campus of or immediately adjacent to an institution, or which have the effect of isolating Medicaid-eligible individuals from the broader community.  In this circumstance, the setting will receive “heightened scrutiny” from DOH and CMS.  However, it is notable that CMS indicates in Guidance on Settings That Have the Effect of Isolating Individuals Receiving HCBS From the Broader Community that most Continuing Care Retirement Communities (CCRCs) “…do not raise the same concerns around isolation … particularly since CCRCs typically include residents who live independently in addition to those who receive HCBS.”  While additional clarification is still needed, we are pleased to learn that campus settings, in and of themselves, are not outside of the HCBS settings requirements.  The CMS “Compliance Toolkit,” as well as the text of the final rule and other materials, can be found here.

LeadingAge NY will be analyzing this guidance to better understand how it may impact our members.  The rule provides the state with a good deal of discretion, however.  We will be working with DOH to ensure that options for seniors are not diminished in the implementation of this rule. 

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828