New Medicaid rule requires patient-centered care for home- and community-based services, defines HCBS settings

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New Medicaid rule requires patient-centered care for home- and community-based services, defines HCB
New Medicaid rule requires patient-centered care for home- and community-based services, defines HCB

Long-term care providers offering home- and community-based services will have to administer person-centered care to qualify for payments through Medicaid, under a final rule issued Friday by the Centers for Medicare & Medicaid Services.

A person receiving HCBS should be able to direct the care planning process, including defining goals and preferences for how to achieve them, the rule states. The planning process also may involve a representative chosen by the beneficiary, and other people who the beneficiary wishes to contribute.

Future guidance will provide more information regarding how states can “operationalize” person-centered planning to comply with the new requirements, CMS stated in a fact sheet accompanying the rule.

CMS also has revised the definition of what constitutes a healthcare setting eligible to participate in an HCBS program. The rule specifically excludes nursing facilities from eligibility. However, CMS made an effort to define eligible settings not through exclusions but by “the nature and quality of individuals' experiences,” the agency explained in a memorandum on this topic.

Among other criteria, eligible settings should be integrated in the community and provide full access to the community, and be selected by the beneficiary from among available options for care, the rule states.

While the rule tightens requirements for HCBS Medicaid waivers by implementing these new provisions, it also includes changes to make it easier for states to access Medicaid funds for home- and community-based care. For example, it gives states the option to combine coverage for multiple target populations under a single waiver.

The final version of the rule revised problematic language in the proposed version, which threatened to uproot residents of assisted living and residential care communities, according to the American Health Care Association/National Center for Assisted Living.

“This is a major relief for thousands of seniors and individuals with disabilities residing in member centers across the country,” stated Mark Parkinson, president and CEO of AHCA/NCAL, the nation's largest long-term care provider association.

Click here to access the rule in advance of its scheduled Jan. 16 publication in the Federal Register.

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