Last week the National Center for Assisted Living sent a letter to the Centers for Medicare and Medicaid Services (CMS) about concerns on the implementation of the home and community-based services (HCBS) waiver final rule. The rule, published in January 2014, presumes that certain settings are institutional and thus ineligible to provide Medicaid HCBS unless they overcome the presumption during a heightened scrutiny review from CMS. These settings include those in a publicly or privately owned facility that provides inpatient treatment, those located in a building on the grounds of or immediately adjacent to a public institution, or those that have the effect of isolating individuals receiving HCBS from the broader community.
NCAL noted concern that the rule could ultimately exclude many AL communities from the Medicaid program. These exclusions would reduce access to this type of home and community-based setting and therefore significantly increase Medicaid expenditures because AL residents would be left with no options other than costlier intuitional settings.
NCAL requested more guidance from CMS, specifically on: (1) operationalizing PCC for people with dementia; (2) criteria for AL communities to overcome a heightened scrutiny review for home and community-based settings that are co-located with or adjacent to an institutional setting; (3) CMS’ process for heightened scrutiny review, including CMS’ timeline for response to settings submitted for review, opportunities for the state or settings to amend files during review, and appeal rights; and (4) response to confusion about how to operationalize CMS’ guidance on new construction (published in April 2016). NCAL also urged CMS officials to visit assisted living communities to ensure that forthcoming guidance reflects the current preferences of AL residents and the true nature of AL communities. Such visits should include communities offering memory care, co-located with a nursing center, and located in a rural area.
In a similar letter sent last month, U.S. Sens. Susan Collins (R-Maine) and Claire McCaskill (D-Mo.), co-chairs of the U.S. Senate Special Committee on Aging, urged CMS to provide information regarding the criteria for determining certain settings ineligible to be a Medicaid HCBS provider.