CMS extends compliance date for Medicaid home care rule

The Trump administration will delay an Obama-era rule that changed what states considered home and community-based settings. The rule is meant to encourage states to use Medicaid funds to keep the elderly and beneficiaries with physical or mental disabilities out of nursing homes.

States had until March 17, 2019, to implement a federally approved plan that would meet the new setting requirements. After that, Medicaid could deny payments for ineligible settings.

States want to keep beneficiaries who need long-term support services out of more expensive facilities. However, many states were simply not ready to make the necessary changes in time, according to Matt Salo, executive director of the National Association of Medicaid Directors.

The CMS Tuesday said that "in light of the difficult and complex nature of this task," it would give states an additional three years to comply with the rule.

The 2014 rulemaking defined community-based settings as locations where individuals have full access to the greater community and opportunities to seek employment and can 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.

Data for fiscal 2014, the last year available, showed that 53% of total Medicaid long-term services and supports expenditures were spent on home and community-based services compared to 45% in 2009. Total federal and state Medicaid long-term services and supports spending was about $152 billion in 2014, up 4% from $146 billion the year before.

Leading Age, a major trade group that represents nursing homes, also is pleased with the delay. A spokeswoman said she hopes the CMS will issue guidance that ensures the number of eligible facilities available to consumers doesn't drop.