Feds Delay Medicaid Integration Rules

people working in a garden, older people a child and a person in a wheelchair

by Andy Jones
June 1, 2017

The Department of Health and Human Services announced May 9 that states will have an additional three years to comply with new regulations designed to incentivize further deinstitutionalization of Medicaid-funded long-term services for people with disabilities.

“States should continue progress in assessing existing operations and identifying milestones for compliance that result in final Statewide Transition Plan approval by March 17, 2019,” Brian Neal, Center for Medicaid and Medicare Services, wrote in the May 9 Bulletin [PDF]. “However, in light of the difficult and complex nature of this task, we will extend the transition period for states to demonstrate compliance with the home and community based settings criteria until March 17, 2022 for settings in which a transition period applies.

“We anticipate that this additional three years will be helpful to states to ensure compliance activities are collaborative, transparent and timely.”

The regulations, finalized in January 2014, sought to reform how the CMS defines “home and community based services,” for each of its three major HCBS waiver programs.

Traditionally, CMS has defined HCBS facilities primarily by contrasting them to traditional institutional facilities, based on their location, geographical and physical characteristics. Contrarily, the new regulations seek a more “outcome based” approach, centered on the individuals' experiences at the facilities.

Specifically, qualifying HCBS services will be required to provide people “full access to the greater community,” including access to employment and cultural opportunities. CMS must offer individuals multiple HCBS housing options, including non-disability specific options.

When entering HCBS facilities, people must receive a lease or similar legally enforceable agreement, specifying their privacy rights and other protections typical in landlord-tenant relationships.

The rules also provide further guidance on prohibition of facilities with institutional-like qualities, such as those adjacent to institutions and hospitals.

The delay did not come as a surprise, as the CMS has so far approved only Tennessee’s plan for implementing the regulations, while most other states were lagging in their progress.

“It is unfortunate the delay had to occur,” Elizabeth Priaulx, senior legal specialist with the National Disability Rights Network, told Kaiser Health News.

A 12-page policy document on the HCBS regulation from the Arc, titled, The 2014 Home and Community Based Services Regulation, What You Need to Know, is available online.

Go online to read the final regulations, facts sheets, and other guidance on the HCBS regulations.

Disability Rights Washington is the designated protection and advocacy agency in Washington and a member of the National Disability Rights Network.