Proposed HCBS Waiver Rules Released

On April 15, 2011, the federal Centers for Medicare and Medicaid (CMS) released proposed rules with the stated purpose of increasing states’ flexibility for use of the 1915(c) Medicaid Waiver.  There are three major provisions:

Option to Combine Disability Groups into One Waiver

The rule would allow multiple disability groups (aged or disabled, developmentally disabled, and mentally ill) into one waiver.  Currently, rules require a separate waiver for each disability group.

Clarification of Allowed HCBS Settings

The proposed rule expressly defines settings where HCBS services may be provided as well as adds a provision whereby the Secretary has full discretion to determine if a setting has “qualities of an institution”.  Under the proposed rule, the HCBS setting definition requirements include:

  1. Must be integrated into the community
  2. Must not be located in building that also provides institutional or custodial care
  3. Must not be located on the grounds or immediately adjacent to a public institution
  4. Must not be a housing complex designed expressly around an individual’s diagnosis or disability as determined by the Secretary
  5. Must not have qualities of an institution as determined by the Secretary including:
    1. Regimental meal and/or sleeping times
    2. Limitations on visitors
    3. Lack of privacy
    4. Other attributes that limit the individual’s ability to engage freely in the community

Person-Centered Planning Required

Previously optional, the proposed rule would require the state to adopt a person-centered planning model.  Under the proposed rule, the person-centered planning requirements include:

  1. Must be based on a person-centered functional assessment with defined requirements including identifying the individual’s strengths, preferences, needs (clinical and supports), and the individual’s desired outcomes
  2. Directed by the individual and may include a representative(s) freely chosen by the individual to assist and include a team of their own choosing
  3. Include paid and non-paid services and supports
  4. Result in a service and support plan in the most integrated community setting
  5. May result in a personal service budget which the individual may direct.

Comments on these proposed rules will be taken through June 14, 2011.  Complete copy of the proposed rule–HCBSProposedRule04152011.

 

 

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