Wednesday, April 11, 2018

HCBS Settings Rule: Spotlight on Resolving Differences between Licensure and the Rule’s Requirements

NCAL Publishes Policy Briefs on HCBS Settings Rule 



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 Licensure: Resolving Differences Between State Assisted Living Licensure Requirements and HCBS Settings Rule. This brief provides information for AL communities in states whose state requirements may not match or comply with the Settings rule. Differences may include regulations regarding: staffing, which may require or encourage co-mingling and cross training of AL and nursing facility staff; discharge, which require discharge of an individual who has reached a higher level of care; and regulations that require controlled egress or other limitations for people with dementia. To date, CMS has approved transition plans that do not change state regulatory language that is counter to the rule, but the states’ plans promise future changes or clarification in provider manuals and other official communications.

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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