Providers of home- and community-based (HCBS) Medicaid services and their state overseers are preparing for a raft of new federal rules that are intended to assure that the people who receive the services have more say in how they are helped and that their living conditions are “non-institutional.”
The regulations could have major consequences for many beneficiaries and the businesses and organizations that help them, particularly for some senior care providers who operate assisted living facilities attached to or in near proximity to nursing homes.
“It’s a big deal for us, a real big deal,” said Cindy Luxem, chief executive of the Kansas Health Care Association, a nursing home trade group. “It really is laying the groundwork on how we use assisted living, residential health care and other facility-type, congregate settings. We’re all going to be very engaged in how we develop this plan.”
Depending on how the rules are implemented, Luxem said, one unintended consequence might be that some people in assisted living could be forced to move into a full nursing or institutional setting because their assisted living arrangement no longer met Medicaid HCBS reimbursement requirements.
“It could work against the powers that be,” Luxem said.
Full nursing care usually is more expensive to the Medicaid program than HCBS.
Luxem said about 25 percent of the clientele served by her group’s members receive Medicaid HCBS benefits.
The new rules have prompted a delay in the processing of two HCBS Medicaid waivers filed earlier this year by Kansas officials with the federal Centers for Medicare and Medicaid Services.
Kansas was seeking renewal of two of its seven HCBS Medicaid waivers - one dealing with services for the developmentally disabled and the other for people disabled by traumatic brain injuries - but both those efforts now are on hold until Sept. 20 in order to incorporate elements of the new rules, which ultimately will apply to the service settings used under each of the various waivers.
Angela de Rocha, a spokesperson for the Kansas Department for Aging and Disability Services, said officials at the federal Centers for Medicare and Medicaid Services gave verbal OK of the extension for the two waiver applications and that agency’s written approval for the delay was pending.
“The extension was agreed to in conversation in advance,” she said. “This will enable the state to successfully complete and ensure an appropriate amount of time is available for the development of a transition plan to implement the new HCBS settings rule, to conduct a 30-day public comment period on the state's proposed transition plan, to compile public comments for consideration and modify the plan based on public comment, as appropriate.”
NSCLC Guide to new HCBS rules
The new regulations became effective March 17 but are expected to be phased in over a period of months and years.
The home- and community-based services in question typically include daily or frequent assistance with dressing, bathing and other routine necessities. They also can include case management and home health services. More than 32,000 Kansans currently receive the services.
The state is required to develop a transition plan for how it will implement the changes. Eight public hearings to gather information for the plan’s preparation are scheduled next week:
Meetings from noon to 1:30 p.m. and from 5:30 p.m. to 7 p.m. at the WSU Metroplex, Room 180, 5015 E. 29th St. North in Wichita.
Conference calls from 10 a.m. to 11 a.m. and from 7 p.m. to 8 p.m. Dial (866) 620-7326 and enter conference code 2850442124.
A conference call from noon to 1 p.m.. Dial (866) 620-7326 and enter conference code 4283583031.
Meetings from noon to 1:30 p.m. and from 5:30 to 7 p.m. at the Holiday Inn Holidome, 200 McDonald Drive in Lawrence.
Meetings from noon to 1:30 p.m. and from 5:30 p.m. to 7 p.m. at the Holiday Inn Express, 4011 Parkview Drive in Pittsburg.
The new rules will require that the various settings where home- and community-based services are provided be “non-institutional” in nature and provide maximum opportunity for the beneficiaries to participate in the daily life of a community. They also call for choice in matters such as food and eating times.
Many details remain unknown because Kansas and other states still must develop their plans for implementing the rules and those plans will require federal approval.
Some HCBS providers said they believe their organizations already comply, at least in part, with the new rules and see them as a matter of little concern as relate to some type of services.
“I don’t think it will have any impact because our whole premise is to serve people in as integrative a way as possible. I just don’t see it as an issue,” with respect to the residential services provided, said Ron Pasmore, chief executive of KETCH, a Wichita nonprofit that provides various programs and services for the developmentally disabled.
But Pasmore said the new rules could have greater consequence for the state's various sheltered work centers that serve the developmentally disabled.
"I do think it will have a potential large impact on center-based day programs that provide work settings," he said. "There is a big push to move persons with (developmental disabilities) out of traditional sheltered work programs into regular employment in the community. These rules will make it more difficult to continue to provide services in segregated work settings."
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