Wednesday, March 28, 2018

NCAL Publishes Policy Briefs on HCBS Settings Rule: Spotlight on Co-location


To support states and providers implementing the Home and Community Based Services (HCBS) Settings Rule, NCAL has partnered with Health Management Associates to create four policy briefs that address areas that have been particularly challenging to ensure that assisted living (AL) continues as an appropriate home and community based setting. These briefs provide background on each issue, aggregate the available guidance from the Centers for Medicare and Medicaid Services (CMS), and provide examples of CMS-approved strategies to comply with the rule from those states with approved transition plans.

This week NCAL is spotlighting its brief on Co-location: Community Integration Options and Resident Choice Are Key in Assessment of Co-Located Assisted Living Communities and Inpatient Facilities.

This brief addresses options for AL communities located in the same building as inpatient facilities, including nursing homes. Each state must identify those settings for heightened scrutiny review by CMS. Co-located settings may demonstrate compliance with the rule by:
  1. differentiating the purpose, design, and programmatic features of the setting; 
  2. demonstrating the degree of physical, programmatic, and financial disconnect between the AL community and inpatient facility; and 
  3. demonstrating how the resident’s experience complies with the rule, including through valid consumer experience surveys. 
AL communities must have a clearly defined approach to support community integration and resident choice. The brief provides concrete examples from CMS guidance and approved transition plans to support states and providers ensure that AL communities continue as an appropriate home and community based setting.

Since 2014, implementation of has been underway to meet the extended 2022 deadline. States continue to work with CMS to have their transition plans approved. States must also assess all HCBS settings for compliance with the rule, and then assemble evidentiary packages for CMS heightened scrutiny review for settings that meet certain criteria.

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