Many Medicare beneficiaries will be able to receive care in the comfort of their homes rather than an institutional setting, thanks to a proposed rule recently published by the Centers for Medicare and Medicaid Services.
"Thousands more Medicaid beneficiaries may now be able to opt for needed long-term support services in their homes rather than institutions," said CMS Acting Administrator Kerry Weems. "Breaking the historic link between long-term care and institutions will level the playing field and give beneficiaries new choices for how they receive care."
The Deficit Reduction Act of 2005 gave states an option to provide home-and-community based services to Medicaid beneficiaries without applying for a demonstration waiver. The proposed rule would provide guidance to states on how to implement this provision.
Under the new rule, states will be able to set their own eligibility or needs-based criteria for providing HCBS. The DRA provision eliminates the previous requirement of imminent risk of institutionalization and allows states to cover Medicaid recipients who have incomes no greater than 150 percent of the federal poverty level, or $15,600 per individual in 2008, and who satisfy the needs-based criteria.
According to CMS officials, the proposed rule also emphasizes "person-centered" care, giving individuals an active role in developing their care plans, and the "self-direction" option, in which states can allow individuals to take charge of their own services.
The services that states may make available under this benefit include case management, homemaker, home health aide, personal care, adult day health, rehabilitation and respite care. The DRA also allows states to provide special services to individuals with chronic mental illness, including day treatment or other partial hospitalization, psychosocial rehabilitation and clinic services.
According to a CMS press release, under the proposed rule, states would no longer have to apply for a waiver to provide HCBS to Medicaid beneficiaries. Under the DRA, states only need an approved state plan amendment (SPA) satisfying the DRA criteria. Once approved by CMS, the SPA does not need to be renewed nor is it subject to some of the same requirements of waivers such as budget neutrality.
Since the DRA made the HCBS option available in January 2007, CMS has provided technical assistance to states wishing to move forward prior to publication of the proposed rule. One state, Iowa, has since been granted an HCBS SPA. Three additional states, Colorado, Nevada and Georgia, have requests pending under CMS review.
"We anticipate states will be eager to take advantage of this new flexibility," Weems said. "The home and community-based services option is a win/win opportunity, giving beneficiaries more control over their care and allowing states to spend Medicaid resources more efficiently."