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 Home, Community-Based Care Centers Required to Develop Person-Centered Care Plans Under New Rule

States will have to come up with person-centered care plans before they’ll be allowed to use Medicaid dollars for home- or community-based services (HCBS), the Obama administration announced Friday.

Under a final rule published by the Centers for Medicare & Medicaid Services (CMS), states won’t get waivers to use Medicaid funds for HCBS unless a patient’s care plan “addresses health and long-term services and support needs in a manner that reflects individual preferences and goals.”

“The rules require that the person-centered planning process is directed by the individual with long-term support needs and may include a representative whom the individual has freely chosen and others chosen by the individual to contribute to the process,” CMS says in a fact sheet issued Friday. “The rule describes the minimum requirements for person-centered plans developed through this process, including that the process results in a person-centered plan with individually identified goals and preferences.”

The new rules include several requirements for the home or community services, and CMS officials that are hopeful that the standards will create “a more outcome-oriented definition of home- and community-based settings, rather than one based solely on a setting’s location, geography, or physical characteristics,” the fact sheet says.

Friday’s rules are a step back from earlier proposals, which would have been more stringent in the definitions of qualified services. Assisted living advocates worried that the definitions would displace up to 139,000 residents.

“This is a major relief for thousands of seniors and individuals with disabilities,” says Mark Parkinson, president and chief executive officer of the American Health Care Association and National Center for Assisted Living, whose groups lobbied furiously to soften the blow. “Our goal was to ensure residents would be able to remain in place at the assisted living and residential care communities they and their families had initially chosen.”

CMS will give states up to one year to come up with a plan to comply with Friday’s rules and up to five more years actually to comply with the rules, but CMS says it hopes that states will make things right “in as brief a period as possible” and will “demonstrate substantial progress toward compliance during any transition period.”

Assisted living advocates, who were most likely to be affected by Friday’s rules, were scheduled to be briefed by CMS officials Friday afternoon.

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