Feds move forward with new Medicaid waiver rule

Erica Bonn brings a favorite painting into her home at Quest Village, an independent living community for adults with developmental disabilities in Orlando, Florida. Federal officials are consolidating plans to implement a new Medicaid rule specifying what community environments should look like. (Joe Burbank/Orlando Sentinel/TNS)

After multiple delays, federal officials say they are moving forward with the implementation of a long-awaited Medicaid rule setting standards for what counts as home and community services for people with disabilities.

The Centers for Medicare & Medicaid Services have described a strategy late last month for imposing a 2014 rule setting out criteria that programs must meet to be considered community-based and therefore eligible for funding provided by Medicaid home and community service waivers.

The rule requires that home and community settings be places where individuals choose to live that are integrated and provide full access to the community. These environments must offer privacy, dignity and respect and allow people with disabilities to make independent choices about their daily activities, their physical environment and the people with whom they come into contact.

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CMS said the changes are expected to have implications for more than one million people receiving home and community services through Medicaid. The agency created the rule after hearing reports of homes being built on the sites of former institutions that were labeled as community-based.

Originally, states had a five-year transition period – ending in 2019 – to comply with the new standards. But in 2017, the Trump administration extended the deadline by three years. Then, with the onset of the COVID-19 pandemic, authorities pushed things back to March 17, 2023.

Now the Biden administration says it is sticking to that plan. Under the recently released strategy, states must have a transition plan approved and meet the new criteria by the next March deadline, but there are some caveats in light of the health emergency. ongoing public, or PHE, caused by the pandemic.

“States and vendors must comply with all configuration criteria not directly impacted by PHE disruptions, including PHE-related workforce challenges, by March 17, 2023” , said CMS in its update. “Time-bound Corrective Action Plans (CAPs) will be available to States to allow additional time to achieve full compliance with the Parameter Criteria that are directly impacted by PHE disruptions, when States document the efforts to meet these requirements to the greatest extent possible, and comply with all other setting criteria.

In justifying the approach, federal Medicaid officials acknowledged that the pandemic has exacerbated a crisis in the workforce of direct support professionals, but said that “there are important aspects of the configuration criteria without related to the pandemic disruptions that should be in place now but are inconsistently implemented across the country.

CMS said these aspects include: individuals should have protections from a lease or similar legal agreement, access to food and visitors at all times, physical accessibility, a person-centered plan and they should have a lockable door and privacy in their unit as well as the ability to decorate and furnish it as they wish. The agency said it expects all states and providers to meet those criteria by the March 2023 deadline or risk losing federal home and community services reimbursement.

“We are happy to see that CMS is holding strong until the 2023 deadline,” said Julia Bascom, executive director of the Autistic Self Advocacy Network. “People with disabilities will have waited nine years for the basic rights guaranteed by the rule, such as the right to lock our doors, decorate our rooms and eat when we are hungry. The corrective action plan option outlined by CMS is a smart strategy for holding states accountable while navigating the complexities of the pandemic. We look forward to working with CMS to ensure that the rule is implemented faithfully in every state and that every person with a disability who is expected to receive HCBS is able to truly experience true community living.

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