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CMS rule encourages states to use Medicaid funds to care for disabled in community settings


By Virgil Dickson
Posted: January 10, 2014 - 5:45 pm ET
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The CMS finalized a rule intended to encourage states to use Medicaid funds to keep elderly and physically and mentally disabled beneficiaries out of nursing homes and provide treatment in home and community-based settings.

In the past, using Medicaid funds in this way would have required a waiver. This is no longer the case as a result of the new policy, carried out under a provision of the Patient Protection and Affordable Care Act.

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“Every person should have a chance to live, work and thrive as a part of their local community,” HHS Secretary Kathleen Sebelius said in a statement.

The rule, issued, Jan. 10, defines the community-based settings as locations where individuals have full access to greater community, opportunities to seek employment and control personal resources. Individuals must have privacy in their sleeping or living quarters, units that have lockable entrance doors and the choice of whether to have a roommate.

The home-care industry welcomed the rule. It will reduce the effort that agencies spend on navigating bureaucratic red tape and reroute that energy to improving care, said William Dombi, executive director of the National Council on Medicaid Home Care, an advocacy group affiliated with the National Association for Home Care & Hospice.

The CMS did not, however, change a provision that raised significant concern from patient advocates when it was floated in draft version of the regulations released in 2012. The final version retains language that disqualifies homes that are deemed too close to a nursing home.

The CMS said in the rule that its “experience has shown that settings in close proximity to institutional settings, whether on the same campus, in the same building, sharing the same staff, and perhaps sharing some common areas, are more likely to be operated in a manner similar to the institution.”

States will have the opportunity to tell the CMS that certain facilities should qualify for reimbursement under the policy if officials are concerned that residents can't access the services they need.

Follow Virgil Dickson on Twitter: @MHvdickson


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