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Home and Community Based Services Proposed Rule Change
April 8, 2008

On March 31, the Centers for Medicare and Medicaid Services announced a proposed rule change regarding Home and Community Based Services (HCBS). The Deficit Reduction Act of 2005 (DRA) gave states a new option to provide these services to Medicaid beneficiaries without applying for a demonstration waiver. Under this option, if approved, states would be able to set their own eligibility or needs-based criteria for providing HCBS. Previously, to qualify for assistance with personal care, home health care, or other services in the community, beneficiaries were required to be at imminent risk of institutionalization. The proposed revision eliminates this requirement and allows states to cover Medicaid recipients with incomes no greater than 150 percent of the federal poverty level (or $15,600 per person in 2008) and who satisfy the needs-based criteria.

The proposed rule emphasizes person-centered care, participation in developing the care plan and the self-direction option in states allowing individuals to take charge of their own services. Services which may be available include:

  • Case management,
  • Homemaker,
  • Home health aid,
  • Adult day health,
  • Habilitation, and
  • Respite care.

States may provide these special services to individuals with chronic mental illness:

  • Day treatment,
  • Partial hospitalization,
  • Psychosocial rehabilitation, and
  • Clinic services.

Under the proposed rule states would no longer have to apply for a waiver but would need an approved state plan amendment satisfying DRA criteria. Once approved the amendment would not need to be renewed and would not be subject to the same requirements as waivers, such as budget neutrality.

The proposed rule was published in the Federal Register April 4 and the public comment period extends until June 3. The proposed rule is available at www.cms.hhs.gov/MedicaidGenInfo/Downloads/CMS2249P.pdf. The complete press release is available at www.cms.hhs.gov, search the newsroom for March 31.

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