Comments to State on Plan to Implement HCBS Settings Rule Due July 31

The Department of Health (DOH) issued a draft transition plan for the State to comply with the federal Home and Community-Based Settings (HCBS) rule that came into effect earlier this year. The State must submit a plan to the Centers for Medicare and Medicaid Services (CMS) with the ultimate objective of being in compliance with the conditions within five years. The State is accepting comments on the plan until July 31, 2014 at OLTCDHCBS@health.state.ny.us; please put ‘comment’ in the subject line. LeadingAge NY has been following this issue closely and is developing comments for the State, so please let us know as soon as possible if you have any feedback you would like us to incorporate.

We believe that this rule will have broad implications that are likely to impact nearly every Medicaid-eligible individual in the State, as well as a vast array of service providers, including those that are not Medicaid providers. A key aspect of the rule is that it sets out the characteristics of a “home and community-based setting” for the purposes of receiving such Medicaid-covered services under a federal HCBS waiver. CMS has indicated that these requirements will apply to 1115 federal waivers, which means that the regulations will ultimately apply to the provision of services to Medicaid managed care and Medicaid Managed Long Term Care (MLTC) enrollees in New York. In addition, we have seen elements of the requirements in the Special Terms and Conditions with govern aspects of the 1115 waiver, which enables mandatory managed care and MLTC enrollment.

For background on the federal rule, click here to view LeadingAge NY information, and here for CMS documents. DOH also created a HCBS Settings Rule website, which houses resources on the rule including a recorded webinar which provides an overview.

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