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 More Guidance Needed On Final Rule Defining HCBS, AL Leaders Say

Assisted living (AL) leaders are calling for more guidance on a final rule defining home- and community-based settings through the Medicaid waiver program. In a letter sent this week to representatives at the Centers for Medicare & Medicaid Services (CMS), the National Center for Assisted Living (NCAL) stressed that the program could limit access to these settings for AL residents.
NCAL leaders cited specific issues with CMS’ implementation of the Olmstead v. L.C. decision and integration principles of the final rule, which “fail to distinguish between the needs and preferences of people with disabilities and of seniors,” the letter says.
The rule, published in the Federal Register in January 2014, presumes that certain settings are institutional and thus ineligible to provide Medicaid home- and community-based services (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.
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.
“In particular, we seek more information regarding the criteria for basing whether certain settings are presumed ineligible and how affected providers can complete the heightened scrutiny process to reverse such a determination, including for 1.) secured memory care units; 2.) assisted living communities located in rural areas; and 3.) assisted living communities that are located in a separate or converted section, or on the campus of a nursing home,” says the senators’ letter.
According to NCAL, there is significant alarm that some AL communities may not overcome the rule’s heightened scrutiny review, and the outcome could force AL residents to find care elsewhere in higher-cost settings. The NCAL letter calls for more guidance from CMS that would shed light for AL providers and state Medicaid programs.
“We want to work alongside CMS to protect the wants and needs of vulnerable individuals who benefit from assisted living,” says Scott Tittle, executive director of NCAL. “While we agree about the importance of ensuring that home- and community-based settings offer resident-centered services that are integrated into the community, it’s also critical to ensure that the settings analysis takes into account what community integration means for seniors.”
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