CMS Issues New Guidance on HCBS Settings Rule
The Centers for Medicare and Medicaid Services (CMS) recently released additional guidance on the implementation of the federal home and community based settings (HCBS) rule. In response to requests for CMS to provide greater clarity for projects in development, they issued Frequently Asked Questions on their approach. CMS states that they would not be able to assess if a setting meet the regulatory criteria until after it was serving people. Further, the guidance states,
“It was CMS’ expectation that after the publication of the final regulation, stakeholders would not invest in the construction of settings that are presumed to have institutional qualities, but would instead create options that promote full community integration, per the regulatory requirements for the 1915(c) waiver program, the 1915(i) HCBS state plan option, and the 1915(k) Community First Choice state plan option, found in 42 CFR 441.301(c)(4)(i), 441.710(a)(1)(i), and 441.530(a)(1)(ii), respectively.”
LeadingAge New York, as well as our national colleagues at LeadingAge, are very concerned about this guidance as it discourages the development of settings that meet the “heightened scrutiny” standard; that is services that are co-located on the same campus or adjacent to a hospital or nursing home ("an institution"). We are in the process of developing a letter to CMS outlining our concerns and the impact this guidance could have on the provider community and the people that rely on those services. Members are encouraged to provide us input.
By way of background, the HCBS settings rule outlines characteristics and requirements for non-institutional services provided to Medicaid beneficiaries under a federal HCBS waiver. Since our shift to managed care and managed long term care in New York is authorized under a federal HCBS waiver; this rule has broad implications in this state. Click here for more background on the HCBS settings rule and New York’s progress towards implementation. Our colleagues at LeadingAge provide additional information about aspects of the rule and recent developments here.
Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828